Healthcare Provider Details

I. General information

NPI: 1598964462
Provider Name (Legal Business Name): PHILIP D PARKER R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 76TH AVENUE WEST
EDMONDS WA
98026
US

IV. Provider business mailing address

3415 159TH PLACE SOUTHEAST
MILL CREEK WA
98012
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-4100
  • Fax:
Mailing address:
  • Phone: 425-338-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN00142701
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: