Provider Demographics
NPI:1902160559
Name:PARKER, W. JEANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:W.
Middle Name:JEANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:W
Other - Middle Name:JEANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 N HARVEY LN
Mailing Address - Street 2:EAGLE
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5339
Mailing Address - Country:US
Mailing Address - Phone:208-866-1265
Mailing Address - Fax:
Practice Address - Street 1:55 W TIETAN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4445
Practice Address - Country:US
Practice Address - Phone:509-525-3720
Practice Address - Fax:509-522-1592
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 1163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily