Provider Demographics
NPI:1407694441
Name:SO, EUN HA (RN)
Entity type:Individual
Prefix:
First Name:EUN
Middle Name:HA
Last Name:SO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:SO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:625 THOMAS BURGIN PKWY APT 534
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7658
Mailing Address - Country:US
Mailing Address - Phone:470-399-7697
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-624-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10002858163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine