Mie Hea Park
Nurse Practitioner in Englewood, NJ. Individual provider (NPI-1).
NPI number1902294598
StatusActive
Last updated in NPPESFeb 8, 2019
Details
- NPI
- 1902294598
- Entity type
- Individual (NPI-1)
- Name
- Mie Hea Park
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 5, 2015
- Last updated
- Feb 8, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | SP019778 | PA | Yes |
| 363LP2300X | Nurse Practitioner, Primary Care | 26NJ00544400 | NJ |
Practice location
475 Grand Ave2nd Floor
Englewood, NJ 07631-4965
Phone 201-541-1111
Mailing address
2290 Galloway Rd Apt B9Bensalem, PA 19020-2956
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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