Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP60320126 | WA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F350353-1 | NY |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SP012857 | PA |
NPI | 1346687019 |
---|---|
Provider Name | Seon Mi Jeong |
First Address | Bronx, NY 10471-3611 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 30/12/2015 |