Provider Demographics
NPI:1073688693
Name:WITTENAUER-LEE, MARGARET (NP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:WITTENAUER-LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SE 7TH AVE SUITE 5550
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4184
Mailing Address - Country:US
Mailing Address - Phone:503-681-4273
Mailing Address - Fax:
Practice Address - Street 1:333 SE 7TH AVE SUITE 5550
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4184
Practice Address - Country:US
Practice Address - Phone:503-681-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090006415N1 FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R104677Medicare PIN