Individual
LISA MARIE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4509 NATIONAL RD, TRIADELPHIA, WV 26059-2013
(304) 639-0873
Mailing address
PO BOX 285, TRIADELPHIA, WV 26059-0285
(304) 639-0873
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
117804
WV
Other
Enumeration date
11/21/2023
Last updated
11/21/2023
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