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Individual
NICOLE LUANNE PARK
Active
Individual
NICOLE LUANNE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
707298
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
22103
CA
Other
Enumeration date
07/31/2012
Last updated
10/12/2016
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