Provider Demographics
NPI:1609196740
Name:PARKER, NICHOLE M (CRNP)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 EXTON RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2509
Mailing Address - Country:US
Mailing Address - Phone:215-674-1689
Mailing Address - Fax:
Practice Address - Street 1:610 LOUIS DR
Practice Address - Street 2:STE 303
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2828
Practice Address - Country:US
Practice Address - Phone:215-957-7980
Practice Address - Fax:215-957-6481
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010534363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health