Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 25NJ00879200 | NJ |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SP012169 | PA |
NPI | 1033530712 |
---|---|
Provider Name | Sura Lee |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103-1461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2013 |
Last Update Date | 11/04/2019 |