Provider Demographics
NPI:1861590036
Name:PARK, WENDY HILL (PHD, CNS-PP ,BC)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:HILL
Last Name:PARK
Suffix:
Gender:F
Credentials:PHD, CNS-PP ,BC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:HILL
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS-PP
Mailing Address - Street 1:207 E 5TH AVE STE 246
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2762
Mailing Address - Country:US
Mailing Address - Phone:541-200-6899
Mailing Address - Fax:541-460-5167
Practice Address - Street 1:207 E 5TH AVE STE 246
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2762
Practice Address - Country:US
Practice Address - Phone:541-200-6899
Practice Address - Fax:541-460-5167
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076849364SP0808X
OR201170009364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q22795Medicare UPIN
GAQ22795Medicare UPIN
GA89BBBJFMedicare PIN