Provider Demographics
NPI:1083256572
Name:LEE, AMY (APRN-FPA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN-FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2586
Mailing Address - Country:US
Mailing Address - Phone:331-221-0570
Mailing Address - Fax:331-221-2745
Practice Address - Street 1:303 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2586
Practice Address - Country:US
Practice Address - Phone:331-221-0570
Practice Address - Fax:331-221-2745
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020213363L00000X
IL277002619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner