Provider Demographics
NPI:1568251841
Name:CHI, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8652 KENYON CT NE UNIT F
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-7437
Mailing Address - Country:US
Mailing Address - Phone:651-800-6016
Mailing Address - Fax:
Practice Address - Street 1:8652 KENYON CT NE UNIT F
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-7437
Practice Address - Country:US
Practice Address - Phone:651-800-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2514101163W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse