Provider Demographics
NPI:1508565599
Name:PARK, MILAE (APN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MILAE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:APN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2849
Mailing Address - Country:US
Mailing Address - Phone:347-699-0290
Mailing Address - Fax:
Practice Address - Street 1:140 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2976
Practice Address - Country:US
Practice Address - Phone:973-933-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01417200363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health