Provider Demographics
NPI:1982624037
Name:LEE, ELIZABETH A
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW 12TH AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4319
Mailing Address - Country:US
Mailing Address - Phone:360-666-8418
Mailing Address - Fax:360-666-8418
Practice Address - Street 1:101 NW 12TH AVE
Practice Address - Street 2:STE 107
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4319
Practice Address - Country:US
Practice Address - Phone:360-666-8418
Practice Address - Fax:360-666-8418
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8157349Medicaid
WAG8805451Medicare PIN
WAF32553Medicare UPIN