Provider Demographics
NPI:1386341048
Name:PARKER, MARVIN (MSN, FNP)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:PARKER
Suffix:
Gender:
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 OAK ALLEY CT STE 505
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1356
Mailing Address - Country:US
Mailing Address - Phone:419-290-3799
Mailing Address - Fax:419-912-5463
Practice Address - Street 1:3454 OAK ALLEY CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1306
Practice Address - Country:US
Practice Address - Phone:419-290-3799
Practice Address - Fax:419-912-5463
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704379022363L00000X, 363L00000X
OHAPRN.CNP.0035385363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner