Provider Demographics
NPI:1831574177
Name:LEE, GERNITA LAZALE (DNP)
Entity type:Individual
Prefix:DR
First Name:GERNITA
Middle Name:LAZALE
Last Name:LEE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3850 GASKINS RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1447
Mailing Address - Country:US
Mailing Address - Phone:804-500-1400
Mailing Address - Fax:
Practice Address - Street 1:50 MEDICAL PARK BLVD STE C
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9275
Practice Address - Country:US
Practice Address - Phone:804-733-8821
Practice Address - Fax:804-861-4365
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172803363LA2100X, 363LF0000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDVVM423F572Medicare PIN