Provider Demographics
NPI:1750152575
Name:PARKER, TESLA ANNE (RN)
Entity type:Individual
Prefix:
First Name:TESLA
Middle Name:ANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TESLA
Other - Middle Name:ANNE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4603 W 2400 N
Mailing Address - Street 2:
Mailing Address - City:CORINNE
Mailing Address - State:UT
Mailing Address - Zip Code:84307-9717
Mailing Address - Country:US
Mailing Address - Phone:801-703-7772
Mailing Address - Fax:
Practice Address - Street 1:3875 STADIUM WAY DEPT 3903
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-3903
Practice Address - Country:US
Practice Address - Phone:801-703-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9648023-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse