Healthcare Provider Details

I. General information

NPI: 1427375211
Provider Name (Legal Business Name): JENNIFER HELEN LEE DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 BROAD STREET RD
GUM SPRING VA
23065-2220
US

IV. Provider business mailing address

3049 BROAD STREET RD
GUM SPRING VA
23065-2220
US

V. Phone/Fax

Practice location:
  • Phone: 804-869-4122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number0301006291
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: