Individual
MALLORY LYNN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CRNP, FNP-C
Contact information
Practice address
250 W MAIN ST, RIDGWAY, PA 15853-1611
(814) 772-8122
Mailing address
101 JENKS ST, BROOKVILLE, PA 15825-2303
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
SP030067
PA
208D00000X
General Practice Physician
Primary
SP030067
PA
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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