Provider Demographics
NPI:1881052371
Name:PARKER, MCKENNA MARIE (RD)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MCKENNA
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5015
Mailing Address - Country:US
Mailing Address - Phone:541-210-8090
Mailing Address - Fax:541-210-5310
Practice Address - Street 1:150 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5015
Practice Address - Country:US
Practice Address - Phone:541-210-8090
Practice Address - Fax:541-210-5310
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR86016398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered