Provider Demographics
NPI:1821131749
Name:LEE, ELANE DOROTHY (NP)
Entity Type:Individual
Prefix:MS
First Name:ELANE
Middle Name:DOROTHY
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1144
Mailing Address - Country:US
Mailing Address - Phone:978-683-3491
Mailing Address - Fax:978-683-3472
Practice Address - Street 1:57 RIVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1144
Practice Address - Country:US
Practice Address - Phone:978-683-3491
Practice Address - Fax:978-683-3472
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3074Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE