Provider Demographics
NPI:1619484748
Name:ABBOTT, HAE-JEON (RN)
Entity Type:Individual
Prefix:
First Name:HAE-JEON
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227B SAINT PAUL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3436
Mailing Address - Country:US
Mailing Address - Phone:585-230-2990
Mailing Address - Fax:
Practice Address - Street 1:95 POINT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-1667
Practice Address - Country:US
Practice Address - Phone:585-339-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY689910-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse