Provider Demographics
NPI:1154476612
Name:LEE, EMILY (CRNP-F)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 WOLF RUN LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2222
Mailing Address - Country:US
Mailing Address - Phone:703-830-7926
Mailing Address - Fax:
Practice Address - Street 1:4167 MERCHANT PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-878-8800
Practice Address - Fax:703-878-2133
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400703400Medicaid
DCC0410037OtherCAREFIRST OF DC
MD88225501OtherCAREFIRST OF MARYLAND
MD400703400Medicaid
MDS73067Medicare UPIN