Provider Demographics
NPI:1639382583
Name:LEE, HYEUK JENNIFER (ANP)
Entity Type:Individual
Prefix:
First Name:HYEUK
Middle Name:JENNIFER
Last Name:LEE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WASHINGTON ST
Mailing Address - Street 2:NJ-02-02-02
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2917
Mailing Address - Country:US
Mailing Address - Phone:973-802-6398
Mailing Address - Fax:973-802-3182
Practice Address - Street 1:213 WASHINGTON ST
Practice Address - Street 2:NJ-02-02-02
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2917
Practice Address - Country:US
Practice Address - Phone:973-802-6398
Practice Address - Fax:973-802-3182
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN11357200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health