Healthcare Provider Details

I. General information

NPI: 1720127269
Provider Name (Legal Business Name): JEANNIE C LEE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHUNGJA RHEE CRNA

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DIVISION ST
OREGON CITY OR
97045-1527
US

IV. Provider business mailing address

21919 SW STAFFORD RD
TUALATIN OR
97062-9729
US

V. Phone/Fax

Practice location:
  • Phone: 503-657-6723
  • Fax:
Mailing address:
  • Phone: 503-502-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number000028918RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000028918CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: