Individual
NICOLE E. PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1040 NW 22ND AVE STE 660, PORTLAND, OR 97210-3083
(503) 413-7162
(503) 413-7148
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00794
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227036
—
OR
Enumeration date
06/27/2005
Last updated
05/19/2016
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