Provider Demographics
NPI:1477992907
Name:YERGEAU, LEE KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:KATHLEEN
Last Name:YERGEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:K
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:595 PAWTUCKET BLVD,
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-970-1607
Mailing Address - Fax:978-970-1115
Practice Address - Street 1:595 PAWTUCKET BLVD,
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-970-1607
Practice Address - Fax:978-970-1115
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0951363AM0700X, 363A00000X, 363AS0400X
MAPA4664363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical