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NPI Code Detail

MEDICARE: MIN JOO BAE NP

MEDICARE: MIN JOO BAE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN03984RI
2363LF0000XFamily Nurse PractitionerAPRN03984RI

General Provider Information

NPI Number : 1588416572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIN JOO BAE NP
Provider Business Mailing Address
First Line : 91 JOHN KESSON LN
Second Line :
City : MIDDLETOWN
State : RI
Zip : 02842-4654
Country : US
Telephone Number : 617-935-3101
Fax Number :
Provider Business Practice Location Address
First Line : 11 FRIENDSHIP ST
Second Line :
City : NEWPORT
State : RI
Zip : 02840-2299
Country : US
Telephone Number : 401-845-3810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2024
Last Update Date : 10/16/2024

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Directions to “ MIN JOO BAE NP” Practice Location

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