Provider Demographics
NPI:1558657049
Name:PARKER, ZARA MICHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:ZARA
Middle Name:MICHELLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 NE EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-1749
Mailing Address - Country:US
Mailing Address - Phone:503-841-0950
Mailing Address - Fax:
Practice Address - Street 1:4170 NE EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-1749
Practice Address - Country:US
Practice Address - Phone:503-841-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60214632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist