Provider Demographics
NPI:1427181502
Name:BAE, MICHELLE H (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:H
Last Name:BAE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 CANDIA LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8810
Mailing Address - Country:US
Mailing Address - Phone:919-599-6238
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8221
Practice Address - Country:US
Practice Address - Phone:919-385-1160
Practice Address - Fax:919-385-1186
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206995363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004702Medicaid