Provider Demographics
NPI:1437884673
Name:CHI, MARTIN FRU (RN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:FRU
Last Name:CHI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 HIGHWAY 36 W APT 204
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4433
Mailing Address - Country:US
Mailing Address - Phone:651-983-2483
Mailing Address - Fax:
Practice Address - Street 1:885 HIGHWAY 36 W APT 204
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4433
Practice Address - Country:US
Practice Address - Phone:651-983-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2466868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2466868OtherMINNESOTA BOARD OF NURSING