Provider Demographics
NPI:1659861177
Name:PARKER, GAIL MERLE (CRM)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MERLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 NE 102ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4064
Mailing Address - Country:US
Mailing Address - Phone:503-257-0381
Mailing Address - Fax:503-257-2927
Practice Address - Street 1:948 NE 102ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4064
Practice Address - Country:US
Practice Address - Phone:503-257-0381
Practice Address - Fax:503-257-2927
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-CRM-120175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15-CRM-120OtherACCBO