Provider Demographics
NPI:1811062136
Name:PARKER, MARY JO V (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:MARY JO
Middle Name:V
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10670 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2325
Mailing Address - Country:US
Mailing Address - Phone:716-759-0493
Mailing Address - Fax:
Practice Address - Street 1:8160 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7241
Practice Address - Country:US
Practice Address - Phone:716-634-0906
Practice Address - Fax:716-204-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000829133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered