Provider Demographics
NPI:1942338124
Name:PARKER, MARY JONES (MS, CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JONES
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, CPNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:JONES PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MS CPNP
Mailing Address - Street 1:222 SEELEY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1208
Mailing Address - Country:US
Mailing Address - Phone:718-871-0660
Mailing Address - Fax:
Practice Address - Street 1:180 6TH AVE
Practice Address - Street 2:LUTHERAN FHCN SCHOOL HEALTH PROGRAM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3507
Practice Address - Country:US
Practice Address - Phone:718-230-5707
Practice Address - Fax:718-230-7546
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380225-1363LP0200X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health