Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305953 | NY |
N | 363LG0600X | Nurse Practitioner - Gerontology | F340834 | NY |
NPI | 1063772747 |
---|---|
Provider Name | Jinhee Park |
First Address | New York, NY 10065-2543 |
Second Address | New York, NY 10065-2543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 20/10/2015 |