Provider Demographics
NPI:1477922847
Name:LEE, JENNA R (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:R
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:560 VAN REED RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1799
Mailing Address - Country:US
Mailing Address - Phone:484-516-2937
Mailing Address - Fax:484-930-0229
Practice Address - Street 1:560 VAN REED RD STE 101
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1799
Practice Address - Country:US
Practice Address - Phone:484-516-2937
Practice Address - Fax:484-930-0229
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily