Provider Demographics
NPI:1467695643
Name:LEE, JENNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8720 FREDERICK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3071
Mailing Address - Country:US
Mailing Address - Phone:402-397-0700
Mailing Address - Fax:402-397-1807
Practice Address - Street 1:8720 FREDERICK ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3071
Practice Address - Country:US
Practice Address - Phone:402-397-0700
Practice Address - Fax:402-397-1807
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant