Provider Demographics
NPI:1669489951
Name:PARKER, JANE (NP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:
Practice Address - Street 1:1001 HART BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8670
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR111529-5363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500001468Medicare ID - Type Unspecified
MNR81948Medicare UPIN