MEDICARE: MARYA JANELLE PARKER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	20672	SC
2	363LP2300X	Primary Care Nurse Practitioner	201910419NP-PP	OR

General Provider Information

NPI Number	:	1114452463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYA JANELLE PARKER NP

Provider Business Mailing Address
First Line	:	3006 KNIGHTBRIDGE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2131
Country	:	US
Telephone Number	:	803-736-8142
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 KNIGHTBRIDGE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2131
Country	:	US
Telephone Number	:	803-736-8142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	11/04/2020

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