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General NPI Number Information
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NPI Number | 1467894253
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Entity Type | Individual
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Provider Name | MEEJIN SHIM CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 670 STONELEIGH AVE
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City | CARMEL
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State | NY
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Zip | 10512-3997
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Country | US
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Telephone | 845-279-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 9072 EMERSON DR
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City | SALINE
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State | MI
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Zip | 48176-8007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 111781
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 398844
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704243812
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 6716401
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 5384
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704243812
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License Number State | MI
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