Basic Information
| Provider Information | |||||||||
| NPI: | 1942302112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 159 | ||||||||
| Address2: | 712 CHINA ST | ||||||||
| City: | CROOKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437310159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409826872 | ||||||||
| FaxNumber: | 7409825551 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 CHINA ST | ||||||||
| Address2: | |||||||||
| City: | CROOKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437310159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409826872 | ||||||||
| FaxNumber: | 7409825551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2481 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.