Jeon, Sang Mi
Jeon, Sang Mi is an individual health care provider with primary practice located at 55 Lake Ave N , Worcester MA 01655-0002. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Jeon, Sang Mi can be contacted via phone (508) 856-1975.Contact Information
Primary practice address
55 Lake Ave N
Worcester MA 01655-0002
Phone: (508) 856-1975
Fax: (774) 442-3999
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Primary Care | 363LP2300X | RN2284588 | Massachusetts |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | RN2284588 | Massachusetts |
Profile Details
| NPI number | 1306221858 |
|---|---|
| LBN Legal business name | Jeon, Sang Mi |
| Credentials | AGPCNP-BC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 27th, 2015 |
| Last updated | Mar 29th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306221858 | NPPES |
| Massachusetts | MEDICAID | 110126617A |
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