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General NPI Number Information
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NPI Number | 1568845295
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Entity Type | Individual
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Provider Name | JIYOUNG CHAE
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Gender | Female
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 253 SAGAMORE PKWY W
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1501
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Country | US
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Telephone | 765-448-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5777
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City | MARYVILLE
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State | TN
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Zip | 37802-5777
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Country | US
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Telephone | 865-246-2104
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Fax | 865-246-2106
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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 | 28193970A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 71005808A
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License Number State | IN
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