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NPI Code Detail

MEDICARE: JOON PARK CRNP

MEDICARE: JOON PARK CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner0024185610VA
2363LF0000XFamily Nurse PractitionerNP500004965DC
3363LF0000XFamily Nurse PractitionerR216697MD

General Provider Information

NPI Number : 1801510516
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOON PARK CRNP
Provider Business Mailing Address
First Line : 20 UNIVERSITY BLVD E
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-2436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20 UNIVERSITY BLVD E
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-2436
Country : US
Telephone Number : 855-910-3278
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2022
Last Update Date : 01/02/2023

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