Provider Demographics
NPI:1033799838
Name:PARKER, LIWAYWAY DAWN (RN)
Entity Type:Individual
Prefix:
First Name:LIWAYWAY
Middle Name:DAWN
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 SW CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8633
Mailing Address - Country:US
Mailing Address - Phone:503-857-5830
Mailing Address - Fax:
Practice Address - Street 1:412 NE FORD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4608
Practice Address - Country:US
Practice Address - Phone:503-434-7525
Practice Address - Fax:503-472-9731
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201401851RN163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice