Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 0024166548 | VA |
N | 363LA2200X | Nurse Practitioner - Adult Health | F303243-1 | NY |
NPI | 1003874595 |
---|---|
Provider Name | Gwendolyn Lee |
First Address | Petersburg, VA 23805-2306 |
Second Address | Cincinnati, OH 45219-2598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |