Provider Demographics
NPI:1992755862
Name:PARK, GLORIA S (RN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:S
Last Name:PARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 N KILDARE AVE
Mailing Address - Street 2:303
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1944
Mailing Address - Country:US
Mailing Address - Phone:847-912-7587
Mailing Address - Fax:
Practice Address - Street 1:4009 N KILDARE AVE
Practice Address - Street 2:303
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1944
Practice Address - Country:US
Practice Address - Phone:847-912-7587
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse