Provider Demographics
NPI:1861742025
Name:PARKER, MARYELLEN (FNP)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 NW KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2242
Mailing Address - Country:US
Mailing Address - Phone:541-383-5958
Mailing Address - Fax:
Practice Address - Street 1:2255 NW SHEVLIN PARK RD STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7134
Practice Address - Country:US
Practice Address - Phone:541-728-2525
Practice Address - Fax:503-917-4971
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22382363LF0000X
OR201501459NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily