Provider Demographics
NPI:1720274863
Name:PARKER, ROANNE MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ROANNE
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 E BASELINE RD STE 126
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-5007
Mailing Address - Country:US
Mailing Address - Phone:480-699-2222
Mailing Address - Fax:480-699-3033
Practice Address - Street 1:7233 E BASELINE RD STE 126
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5007
Practice Address - Country:US
Practice Address - Phone:480-699-2222
Practice Address - Fax:480-699-3033
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2868207Q00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ301197Medicaid