Provider Demographics
NPI:1841476249
Name:LEE, EUNYOUNG (ANP, PHD)
Entity type:Individual
Prefix:
First Name:EUNYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:ANP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 WHITFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1401
Mailing Address - Country:US
Mailing Address - Phone:540-586-8889
Mailing Address - Fax:540-586-8717
Practice Address - Street 1:1710 WHITFIELD DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1401
Practice Address - Country:US
Practice Address - Phone:540-586-8889
Practice Address - Fax:540-586-8717
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2729363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health