Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | NP16060 | CA |
NPI | 1003955667 |
---|---|
Provider Name | Mrs. Nuri Park |
First Address | Dallas, TX 75201-7111 |
Second Address | Dallas, TX 75201-7111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 01/12/2021 |