Provider Demographics
NPI:1578019758
Name:LEE, BRENNA M (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:M
Other - Last Name:BURKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2500 W 12TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4500
Mailing Address - Country:US
Mailing Address - Phone:814-877-8730
Mailing Address - Fax:814-877-8731
Practice Address - Street 1:2500 W 12TH ST STE C
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4500
Practice Address - Country:US
Practice Address - Phone:814-877-8730
Practice Address - Fax:814-877-8731
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant