Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ01020700 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ01020700 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | SP021478 | PA |
NPI | 1023640406 |
---|---|
Provider Name | Juliet Lee |
First Address | Marlton, NJ 08053-4197 |
Second Address | Moorestown, NJ 08057-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2020 |
Last Update Date | 19/10/2020 |