Provider Demographics
NPI:1235818634
Name:LEE, BRENNAH KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENNAH
Middle Name:KATHERINE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21003 ROSTORMEL CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4782
Mailing Address - Country:US
Mailing Address - Phone:703-629-7155
Mailing Address - Fax:
Practice Address - Street 1:21003 ROSTORMEL CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4782
Practice Address - Country:US
Practice Address - Phone:703-629-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110009417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant