Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 102970 | CO |
NPI | 1174827984 |
---|---|
Provider Name | Ms. Jeanne Jiyoung Min |
First Address | Parker, CO 80138-7916 |
Second Address | Phoenix, AZ 85037-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 29/10/2021 |