MEDICARE: BRENDA PARKER

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	164W00000X	Licensed Practical Nurse	298833-1	NY
2	363LF0000X	Family Nurse Practitioner	355210-01	NY

General Provider Information

NPI Number	:	1285985242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA PARKER

Provider Business Mailing Address
First Line	:	41 PROSPECT ST
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-1027
Country	:	US
Telephone Number	:	315-427-6749
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 PROSPECT ST
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-1027
Country	:	US
Telephone Number	:	607-591-3581
Fax Number	:

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

Provider Enumeration Date	:	09/30/2012
Last Update Date	:	03/25/2025

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Directions to “ BRENDA PARKER ” Practice Location

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