| Doctor Name: | JANIE PARK |
| NPI Number: | 1003820010 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RNFA |
| License Number: | RN 032660 |
| Business Practice Address: | 604 W Medina Ave Mesa, AZ - 852106848 |
| Business Phone Number: | 4805452610 |
| Business Fax Number: | 4805452673 |
| Mailing Address: | 604 W Medina Ave, MESA |
| State: | AZ |
| Postal Code: | 852106848 |
| Phone Number: | 4805452610 |
| Fax Number: | 4805452673 |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | RN 032660 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |