Individual
MICAIAH PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
1720 LLANO ST, SANTA FE, NM 87505-5412
(505) 920-6860
Mailing address
1720 LLANO ST, SANTA FE, NM 87505-5412
(505) 920-6860
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
374970
NM
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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