MEDICARE: MRS. ERIN ROXANNE 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	174400000X	Specialist	84749	OR

General Provider Information

NPI Number	:	1487193942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN ROXANNE PARKER

Provider Business Mailing Address
First Line	:	PO BOX 83186
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97283-0186
Country	:	US
Telephone Number	:	503-709-9675
Fax Number	:	503-285-5362

Provider Business Practice Location Address
First Line	:	7210 N OATMAN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5836
Country	:	US
Telephone Number	:	503-709-9675
Fax Number	:	503-285-5362

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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