Individual
JENNY PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1718 E 4TH ST STE 807, CHARLOTTE, NC 28204-3280
(704) 316-3297
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5009817
NC
363LA2200X
Adult Health Nurse Practitioner
APRN002222
NV
363LP2300X
Primary Care Nurse Practitioner
F3064361
NY
Other
Enumeration date
05/28/2013
Last updated
03/17/2018
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