Individual
KAITLIN NOEL PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3500 FRANCISCAN WAY STE 400, MICHIGAN CITY, IN 46360-0033
(219) 878-8200
(219) 878-8331
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28215463A
IN
363LF0000X
Family Nurse Practitioner
Primary
71013386A
IN
Other
Enumeration date
12/01/2022
Last updated
06/19/2024
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