Provider Demographics
NPI:1154392496
Name:PARKER, REBECCA SUZANNE (RN, MN, CNM, FNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUZANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, MN, CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1263
Mailing Address - Country:US
Mailing Address - Phone:503-819-3712
Mailing Address - Fax:541-708-0230
Practice Address - Street 1:796 OAK ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1263
Practice Address - Country:US
Practice Address - Phone:503-819-3712
Practice Address - Fax:541-708-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150132NP363LF0000X
OR91007142367A00000X
WAAP 30004962367A00000X
CA1876367A00000X
WAAP30004962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013904000OtherBCBS
OR273945Medicaid