Provider Demographics
NPI:1285151159
Name:PARK, SUN HEE (CRNP)
Entity type:Individual
Prefix:
First Name:SUN HEE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 BUTLER PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1510
Mailing Address - Country:US
Mailing Address - Phone:610-825-5741
Mailing Address - Fax:610-825-2501
Practice Address - Street 1:4070 BUTLER PIKE STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1510
Practice Address - Country:US
Practice Address - Phone:610-825-5741
Practice Address - Fax:610-825-2501
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015868363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP015868OtherCRNP