Provider Demographics
NPI:1669531935
Name:LEE, JENNIFER A (MSN, ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANITA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:788 8TH AVE SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401
Mailing Address - Country:US
Mailing Address - Phone:319-832-2328
Mailing Address - Fax:319-832-1168
Practice Address - Street 1:788 8TH AVE SE
Practice Address - Street 2:SUITE 400
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2119
Practice Address - Country:US
Practice Address - Phone:319-832-2328
Practice Address - Fax:319-832-1168
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH104170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3899OtherMEDICARE GROUP RR
71960OtherMEDICARE, GROUP