Individual
TAE JOON PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, PMHNP-BC
Contact information
Practice address
921 E FORT AVE STE 100, BALTIMORE, MD 21230-5135
(667) 668-2566
Mailing address
603 S ROSE ST, BALTIMORE, MD 21224-3759
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R218239
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R218239
MD
Other
Enumeration date
05/30/2023
Last updated
07/14/2023
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