Basic Information
| Provider Information | |||||||||
| NPI: | 1982603783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660599 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752660599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145904105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5201 HARRY HINES BLVD | ||||||||
| Address2: | DEPT. OF ANESTHESIOLOGY | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145908329 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 257478 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 89473C | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 088977602 | 05 | TX | MEDICAID |