Provider Demographics
NPI:1497726053
Name:PARKER, MARLYCE E (APN)
Entity Type:Individual
Prefix:
First Name:MARLYCE
Middle Name:E
Last Name:PARKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 S WISHING WELL WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-8880
Mailing Address - Country:US
Mailing Address - Phone:702-985-9660
Mailing Address - Fax:
Practice Address - Street 1:2767 SILVER CREEK RD
Practice Address - Street 2:SUITE A
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8227
Practice Address - Country:US
Practice Address - Phone:928-704-6741
Practice Address - Fax:928-704-6779
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000821363LG0600X
AZAP3966363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504343Medicaid
NV100504343Medicaid
R59516Medicare UPIN