Provider Demographics
NPI:1952936668
Name:PARKER, MARY-VIRGINIA HYE-JIN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY-VIRGINIA
Middle Name:HYE-JIN
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N 1700 W STE A
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8804
Mailing Address - Country:US
Mailing Address - Phone:801-773-4840
Mailing Address - Fax:801-519-3164
Practice Address - Street 1:2121 N 1700 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8803
Practice Address - Country:US
Practice Address - Phone:801-777-3484
Practice Address - Fax:801-519-3164
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9404087-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1952936668Medicaid