Healthcare Provider Details

I. General information

NPI: 1558703546
Provider Name (Legal Business Name): HANNAH YOUNG LEE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

386 FORT WASHINGTON AVE APT 1E
NEW YORK NY
10033-6828
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382429
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number657199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: