Provider Demographics
NPI:1588338545
Name:PARK, JEAN S
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:S
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 HARBOUR POINTE BLVD UNIT EE106
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5221
Mailing Address - Country:US
Mailing Address - Phone:425-407-3662
Mailing Address - Fax:
Practice Address - Street 1:5031 168TH ST SW STE 150
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-5717
Practice Address - Country:US
Practice Address - Phone:425-835-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide