Provider Demographics
NPI:1275213183
Name:PARK-CLINTON, EUNICE (CRNP)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:PARK-CLINTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 AYRESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5822
Mailing Address - Country:US
Mailing Address - Phone:267-471-5126
Mailing Address - Fax:
Practice Address - Street 1:2235 AYRESHIRE DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5822
Practice Address - Country:US
Practice Address - Phone:267-471-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027553363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty