Healthcare Provider Details

I. General information

NPI: 1427181502
Provider Name (Legal Business Name): MICHELLE H BAE CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/26/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM ST
RALEIGH NC
27617-8221
US

IV. Provider business mailing address

236 CANDIA LN
CARY NC
27519-8810
US

V. Phone/Fax

Practice location:
  • Phone: 919-385-1160
  • Fax: 919-385-1186
Mailing address:
  • Phone: 919-599-6238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number206995
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: