Provider Demographics
NPI:1972819597
Name:LEE, CATHY JO (ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:JO
Last Name:LEE
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:MS
Other - First Name:CATHY
Other - Middle Name:JO
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:185 PILGRIM RD STE 319
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5324
Mailing Address - Country:US
Mailing Address - Phone:617-632-7723
Mailing Address - Fax:617-632-7760
Practice Address - Street 1:185 PILGRIM RD # 319
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-7723
Practice Address - Fax:617-632-7760
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9230322363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health