Healthcare Provider Details

I. General information

NPI: 1093416489
Provider Name (Legal Business Name): ANN B LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 177TH ST SE
BOTHELL WA
98012-6674
US

IV. Provider business mailing address

3122 177TH ST SE
BOTHELL WA
98012-6674
US

V. Phone/Fax

Practice location:
  • Phone: 425-343-6492
  • Fax:
Mailing address:
  • Phone: 425-343-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61459044
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: