Provider Demographics
NPI:1497414635
Name:NERYCHEL, HYO JIN (CRNA)
Entity Type:Individual
Prefix:
First Name:HYO JIN
Middle Name:
Last Name:NERYCHEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 BRICKLEY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1114
Mailing Address - Country:US
Mailing Address - Phone:312-914-1322
Mailing Address - Fax:
Practice Address - Street 1:2104 BRICKLEY ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1114
Practice Address - Country:US
Practice Address - Phone:312-914-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI138477367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered