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Individual
MICHELLE MYOUNGWOO PARK
Active
Individual
MICHELLE MYOUNGWOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP, RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
847491
CA
163WC1500X
Community Health Registered Nurse
87621
CA
363LF0000X
Family Nurse Practitioner
Primary
95002767
CA
Other
Enumeration date
08/19/2015
Last updated
08/16/2021
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