Individual
SANG MI JEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 756-9771
(508) 909-7735
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2284588
MA
363LP2300X
Primary Care Nurse Practitioner
RN2284588
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110126617A
—
MA
Enumeration date
07/27/2015
Last updated
02/27/2026
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