Healthcare Provider Details

I. General information

NPI: 1326956020
Provider Name (Legal Business Name): LINA PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BROADWAY STREET SUITE 315
VANCOUVER WA
98660-3310
US

IV. Provider business mailing address

18220 132ND AVE E
PUYALLUP WA
98374-1249
US

V. Phone/Fax

Practice location:
  • Phone: 253-279-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: