Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | OY012947 | PA |
NPI | 1013151919 |
---|---|
Provider Name | Brenda Park |
First Address | Seattle, WA 98133-8401 |
Second Address | Seattle, WA 98133-8401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 23/09/2015 |