Provider Demographics
NPI:1225385669
Name:PARKER, KATHERINE LYNN
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LYNN
Other - Last Name:NORDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:933 INSPIRATION PKWY S
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55003-1611
Mailing Address - Country:US
Mailing Address - Phone:651-235-1391
Mailing Address - Fax:
Practice Address - Street 1:933 INSPIRATION PKWY S
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:MN
Practice Address - Zip Code:55003-1611
Practice Address - Country:US
Practice Address - Phone:651-235-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202683-3163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical