Healthcare Provider Details

I. General information

NPI: 1205237104
Provider Name (Legal Business Name): JAMES M LEE APN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 UNIVERSITY DR
NAPERVILLE IL
60565-3485
US

IV. Provider business mailing address

2128 UNIVERSITY DR
NAPERVILLE IL
60565-3485
US

V. Phone/Fax

Practice location:
  • Phone: 630-877-1533
  • Fax:
Mailing address:
  • Phone: 630-877-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041453293
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001733
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277001733
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020199
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019688
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277001733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: