Healthcare Provider Details

I. General information

NPI: 1306319413
Provider Name (Legal Business Name): JENNIFER B. LEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 EAST ST
NEW HAVEN CT
06511-5838
US

IV. Provider business mailing address

311 EAST ST
NEW HAVEN CT
06511-5838
US

V. Phone/Fax

Practice location:
  • Phone: 203-927-2191
  • Fax: 325-221-2031
Mailing address:
  • Phone: 203-927-2191
  • Fax: 325-221-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG01190045
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8069
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8069
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: