Provider Demographics
NPI:1700848629
Name:LEE, ANGELA DELORES (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DELORES
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1039 YEADON AVENUE
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3811
Mailing Address - Country:US
Mailing Address - Phone:610-626-7419
Mailing Address - Fax:610-626-5683
Practice Address - Street 1:2401 S 67TH STREET
Practice Address - Street 2:JOHN BARTRAM HIGH SCHOOL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:215-492-6450
Practice Address - Fax:215-492-2324
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN214902L163W00000X
PASP005013B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner