Provider Demographics
NPI:1851817035
Name:PARKER, JOLEEN MAE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:JOLEEN
Middle Name:MAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:JOLEEN
Other - Middle Name:MAE
Other - Last Name:POLCYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2809
Mailing Address - Country:US
Mailing Address - Phone:503-239-8101
Mailing Address - Fax:
Practice Address - Street 1:424 NE 22ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2809
Practice Address - Country:US
Practice Address - Phone:503-239-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201704536RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse