Provider Demographics
NPI:1548254550
Name:PARKER, REBECCA M (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N 400 W
Mailing Address - Street 2:STE C10
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1909
Mailing Address - Country:US
Mailing Address - Phone:801-224-6767
Mailing Address - Fax:801-221-1052
Practice Address - Street 1:175 N 400 W
Practice Address - Street 2:STE C10
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:801-224-6767
Practice Address - Fax:801-221-1052
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188780-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR34506Medicare UPIN
UT005582311Medicare ID - Type Unspecified