Provider Demographics
NPI:1003955667
Name:PARK, NURI (NP)
Entity Type:Individual
Prefix:MRS
First Name:NURI
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N SAINT PAUL ST STE 1340
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7111
Mailing Address - Country:US
Mailing Address - Phone:855-961-1942
Mailing Address - Fax:866-702-0882
Practice Address - Street 1:750 N SAINT PAUL ST STE 1340
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7111
Practice Address - Country:US
Practice Address - Phone:855-961-1942
Practice Address - Fax:866-702-0882
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16060363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology