Provider Demographics
NPI:1679876031
Name:PARHAM, MARIANNE N (RNFA)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:N
Last Name:PARHAM
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 W SAINT MARYS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2615
Mailing Address - Country:US
Mailing Address - Phone:520-624-0888
Mailing Address - Fax:520-624-0091
Practice Address - Street 1:1707 W SAINT MARYS RD STE 205
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2615
Practice Address - Country:US
Practice Address - Phone:520-624-0888
Practice Address - Fax:520-624-0091
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN086463163WR0006X
AZAP8610207X00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ610774Medicaid