Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024178234 | VA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 0024178234 | VA |
NPI | 1033769906 |
---|---|
Provider Name | Sun Mi Cho |
First Address | Baltimore, MD 21297-3174 |
Second Address | Leesburg, VA 20176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 20/12/2021 |