Provider Demographics
NPI:1265582480
Name:LEE, GERALDINE JENNIFER (ARNP, LM)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:JENNIFER
Last Name:LEE
Suffix:
Gender:F
Credentials:ARNP, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2062
Mailing Address - Country:US
Mailing Address - Phone:206-525-5777
Mailing Address - Fax:206-528-9881
Practice Address - Street 1:9709 3RD AVE NE FL 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2077
Practice Address - Country:US
Practice Address - Phone:206-525-5777
Practice Address - Fax:206-528-9881
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000306176B00000X
WAAP60776005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife