Provider Demographics
NPI:1922201581
Name:LEE, JENNIFER M (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:CICERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-520-5307
Mailing Address - Fax:
Practice Address - Street 1:12039 NE 128TH ST STE 500
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3029
Practice Address - Country:US
Practice Address - Phone:425-899-2365
Practice Address - Fax:425-899-2375
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60223718207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0279954OtherL & I
WA1386823029Medicaid
WA8901077OtherMEDICARE
WAMD60223718OtherMEDICAL LICENSE NUMBER