Provider Demographics
NPI:1457883175
Name:PARK, TRISHA
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:LUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9108 HARLEQUIN CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9108 HARLEQUIN CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-9753
Practice Address - Country:US
Practice Address - Phone:720-841-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse