Provider Demographics
NPI:1669568176
Name:LEE, JILL LUNSFORD (CPNP-AC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LUNSFORD
Last Name:LEE
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST.
Mailing Address - Street 2:MMC 484
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-9139
Mailing Address - Fax:612-626-2815
Practice Address - Street 1:420 DELAWARE ST.
Practice Address - Street 2:MMC 484
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-624-9139
Practice Address - Fax:612-626-2815
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 185565-2363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics