Provider Demographics
NPI:1720781362
Name:NJERI, LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:NJERI
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 CORPORATE DR STE C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4917
Mailing Address - Country:US
Mailing Address - Phone:410-505-7952
Mailing Address - Fax:
Practice Address - Street 1:9309 BELAIR RD UNIT D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1605
Practice Address - Country:US
Practice Address - Phone:410-505-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR240476363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health