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General NPI Number Information
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NPI Number | 1033127477
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Entity Type | Individual
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Provider Name | MARY ELLEN BURGESS-PARKER CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 1401 RAINBOW DR
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City | GADSDEN
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State | AL
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Zip | 35901-5319
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Country | US
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Telephone | 256-543-9497
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Fax | 256-543-1343
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Provider Business Mailing Address
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Address Line | 200 W MEIGHAN BLVD SUITE E
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City | GADSDEN
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State | AL
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Zip | 35901-3210
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Country | US
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Telephone | 256-467-4731
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Fax | 256-467-4734
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1073481
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1073481
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License Number State | AL
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