Healthcare Provider Details

I. General information

NPI: 1477467124
Provider Name (Legal Business Name): HB PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH ELIZABETH PARK

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N CLAY ST
EDINBURGH IN
46124-1103
US

IV. Provider business mailing address

402 N CLAY ST
EDINBURGH IN
46124-1103
US

V. Phone/Fax

Practice location:
  • Phone: 812-371-9963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28251217C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: