Individual
CLEOPATRA C PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3864 N 27TH AVE, PHOENIX, AZ 85017-4703
(602) 685-6000
(602) 212-6250
Mailing address
3003 N CENTRAL AVE STE 400, PHOENIX, AZ 85012-2929
(602) 685-6000
(602) 302-7925
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
076714
AZ
363LP0200X
Pediatric Nurse Practitioner
Primary
AP1818
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP1818
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841264
—
AZ
Enumeration date
08/19/2006
Last updated
07/18/2022
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