Provider Demographics
NPI:1609970888
Name:LEE, ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-522-9800
Mailing Address - Fax:410-338-3420
Practice Address - Street 1:1000 E EAGER STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5533
Practice Address - Country:US
Practice Address - Phone:410-522-9800
Practice Address - Fax:410-522-5136
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR072044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD063621500Medicaid
MDK818B670Medicare UPIN
MD063621500Medicaid