Provider Demographics
NPI:1942555636
Name:PARKER, THERESE YONEKO
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:YONEKO
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 E MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4640
Mailing Address - Country:US
Mailing Address - Phone:215-364-8412
Mailing Address - Fax:
Practice Address - Street 1:669 E MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4640
Practice Address - Country:US
Practice Address - Phone:215-364-8412
Practice Address - Fax:215-364-8730
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN628890163W00000X
PASP012416363LA2200X
PASP014459363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health