Provider Demographics
NPI:1336701853
Name:LEE, ELISE JANINE (NP-C)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:JANINE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LENNON LN STE 150
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2475
Mailing Address - Country:US
Mailing Address - Phone:925-930-9373
Mailing Address - Fax:925-945-3850
Practice Address - Street 1:355 LENNON LN STE 150
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2475
Practice Address - Country:US
Practice Address - Phone:925-930-9373
Practice Address - Fax:925-945-3850
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty