Individual
MS. LISA S. PARK
Active
Individual
MS. LISA S. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95008110
CA
367500000X
Certified Registered Nurse Anesthetist
209011661
IL
Other
Enumeration date
10/19/2017
Last updated
05/09/2022
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