Provider Demographics
NPI:1376846618
Name:LEE, SUSAN S (CNRP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:CNRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:610-941-4208
Mailing Address - Fax:610-941-4158
Practice Address - Street 1:1800 SULLIVAN TRL
Practice Address - Street 2:SUITE 320
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8397
Practice Address - Country:US
Practice Address - Phone:610-941-4208
Practice Address - Fax:610-941-4158
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily