Provider Demographics
NPI:1457989840
Name:LEE, JENEVIEVE (NP-C)
Entity Type:Individual
Prefix:
First Name:JENEVIEVE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GERMANTOWN PIKE STE H2
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2488
Mailing Address - Country:US
Mailing Address - Phone:484-351-8031
Mailing Address - Fax:
Practice Address - Street 1:1000 GERMANTOWN PIKE STE H2
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2488
Practice Address - Country:US
Practice Address - Phone:484-351-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN676402163WM0705X
PASP021748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical