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Individual

ALICE SOO PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3375
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-4739
(215) 707-3677

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR14281300
NJ
163W00000X
Registered Nurse
567761
NY
163W00000X
Registered Nurse
RN635789
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
SP012125
PA

Other

Enumeration date
11/22/2010
Last updated
02/20/2013
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