Provider Demographics
NPI:1164964342
Name:LEE, JOANNA M
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:LEE
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 1:5201 WILLOW SPRINGS RD STE 380
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6539
Mailing Address - Country:US
Mailing Address - Phone:708-354-2550
Mailing Address - Fax:708-354-4552
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 380
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6539
Practice Address - Country:US
Practice Address - Phone:708-354-2550
Practice Address - Fax:708-354-4552
Is Sole Proprietor?:No
Enumeration Date:2016-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner