Provider Demographics
NPI:1831999648
Name:PARK, ADRIANA (MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:PARK
Suffix:
Gender:
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAME
Mailing Address - Street 1:5520 MANSE RD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89061-7005
Mailing Address - Country:US
Mailing Address - Phone:559-623-6057
Mailing Address - Fax:
Practice Address - Street 1:5520 MANSE RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89061-7005
Practice Address - Country:US
Practice Address - Phone:559-623-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651409163WC0400X
CAL-84670163WL0100X
NV838308163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant