Individual
MRS. LISA M PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
11729 ROE AVE, LEAWOOD, KS 66211-2605
(913) 345-8404
Mailing address
19003 W 163RD CT, OLATHE, KS 66062-3564
(913) 645-2255
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-75279-101
KS
Other
Enumeration date
04/06/2012
Last updated
04/06/2012
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