Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95000125 | CA |
NPI | 1093133571 |
---|---|
Provider Name | Glenna Pyo Lee |
First Address | San Francisco, CA 94132-1722 |
Second Address | San Francisco, CA 94132-1722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 26/03/2015 |