Healthcare Provider Details

I. General information

NPI: 1649992405
Provider Name (Legal Business Name): HANNAH PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 TRENT DR
DURHAM NC
27710-3038
US

IV. Provider business mailing address

102 HARVEST OAKS LN UNIT 38
DURHAM NC
27703-4678
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-4248
  • Fax:
Mailing address:
  • Phone: 530-519-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number348455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: