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Individual

SUSAN S PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.N.P.

Contact information

Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-3366
(602) 933-4166
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
(602) 933-1820

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
583996
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
AP3469
AZ
363LP0200X
Pediatric Nurse Practitioner
RN159828/AP3469
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
471651
AZ
Enumeration date
05/30/2007
Last updated
01/24/2018
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