Healthcare Provider Details

I. General information

NPI: 1326117268
Provider Name (Legal Business Name): SUN-MI CHAE PHD, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 OXFORD ST. STOP 9025 COLLEGE OF NURSING ROOM 349
GRAND FORKS ND
58202-9025
US

IV. Provider business mailing address

2750 S 38TH ST APT 220
GRAND FORKS ND
58201-5971
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-4557
  • Fax: 701-777-4096
Mailing address:
  • Phone: 701-777-4557
  • Fax: 701-777-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR31512
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: