Provider Demographics
NPI:1356322614
Name:LEE, JOYCE RENEE (CRNP-F)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:RENEE
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA I, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-665-9696
Mailing Address - Fax:240-420-5715
Practice Address - Street 1:1150 PROFESSIONAL CT
Practice Address - Street 2:SUITE P
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4100
Practice Address - Country:US
Practice Address - Phone:301-665-9696
Practice Address - Fax:240-420-5715
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS96804Medicare UPIN
MD60775101OtherBC/BS
1457444300OtherUS DEPT OF LABOR
MD200509300Medicaid
DCB3890006OtherBC/BS
MDS96804Medicare UPIN