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General NPI Number Information
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NPI Number | 1861742025
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Entity Type | Individual
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Provider Name | MARYELLEN PARKER FNP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2255 NW SHEVLIN PARK RD STE 110
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City | BEND
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State | OR
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Zip | 97703-7134
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Country | US
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Telephone | 541-728-2525
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Fax | 503-917-4971
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Provider Business Mailing Address
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Address Line | 1375 NW KINGSTON AVE
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City | BEND
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State | OR
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Zip | 97701-2242
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Country | US
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Telephone | 541-383-5958
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Fax |
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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 | 22382
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201501459NP-PP
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License Number State | OR
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