Provider Demographics
NPI:1528603479
Name:LEE, YUN S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:YUN
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 ANDERSON AVE APT 22A
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2711
Mailing Address - Country:US
Mailing Address - Phone:201-819-6178
Mailing Address - Fax:
Practice Address - Street 1:1590 ANDERSON AVE APT 22A
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2711
Practice Address - Country:US
Practice Address - Phone:201-819-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309379-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health