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Individual

JANIE PARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RNFA

Contact information

Practice address
604 W MEDINA AVE, MESA, AZ 85210-6848
(480) 545-2610
(480) 545-2673
Mailing address
604 W MEDINA AVE, MESA, AZ 85210-6848
(480) 545-2610
(480) 545-2673

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
RN 032660
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1Z4903
HEALTHNET AZ
AZ
01
AZ0169450
BCBS AZ
AZ
Enumeration date
07/27/2006
Last updated
07/08/2007
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