Individual
KIMIKO PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
29866 SPRING HILL DR, SOUTHFIELD, MI 48076-5735
(248) 798-3969
Mailing address
19785 W 12 MILE RD STE 389, SOUTHFIELD, MI 48076-2584
(248) 798-3969
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704276586
MI
363LP2300X
Primary Care Nurse Practitioner
4704276586
MI
Other
Enumeration date
08/23/2017
Last updated
02/09/2021
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