1326310533 NPI number — MRS. NORAH N PARKER PA-C

Table of content: MRS. NORAH N PARKER PA-C (NPI 1326310533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326310533 NPI number — MRS. NORAH N PARKER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
NORAH
Provider Middle Name:
N
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326310533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 S MILL AVE
Provider Second Line Business Mailing Address:
280
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282-6757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-305-2888
Provider Business Mailing Address Fax Number:
480-305-2889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1982 W MAIN ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201-6916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-677-8282
Provider Business Practice Location Address Fax Number:
480-535-0962
Provider Enumeration Date:
02/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  5053 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 728352 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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