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NPI Code Detail

MEDICARE: MIRRIAM LEE CRNP

MEDICARE: MIRRIAM LEE CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner26NJ15363800NJ
2363LP0808XPsychiatric/Mental Health Nurse PractitionerSP030975PA

General Provider Information

NPI Number : 1447056429
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRRIAM LEE CRNP
Provider Business Mailing Address
First Line : 2600 N AMERICAN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19133-3413
Country : US
Telephone Number : 215-739-2669
Fax Number :
Provider Business Practice Location Address
First Line : 100 W LEHIGH AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19133-4039
Country : US
Telephone Number : 215-203-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2025
Last Update Date : 06/05/2026

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