Basic Information
Provider Information
NPI: 1598338634
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOE
FirstName: MONICA
MiddleName: YOUNGEUN
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 N GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011524
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber: 4106057913
Practice Location
Address1: 10 N GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011524
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2021
LastUpdateDate: 07/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XR233433MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


Home