Provider Demographics
NPI:1942302112
Name:PARKER, MARINA A (PAC)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:712 CHINA ST
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-0159
Mailing Address - Country:US
Mailing Address - Phone:740-982-6872
Mailing Address - Fax:740-982-5551
Practice Address - Street 1:712 CHINA ST
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-0159
Practice Address - Country:US
Practice Address - Phone:740-982-6872
Practice Address - Fax:740-982-5551
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant