Healthcare Provider Details

I. General information

NPI: 1396449104
Provider Name (Legal Business Name): JENNA RENEE LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E BROADWAY
MONONA WI
53716-4023
US

IV. Provider business mailing address

1050 E BROADWAY
MONONA WI
53716-4023
US

V. Phone/Fax

Practice location:
  • Phone: 608-222-8779
  • Fax:
Mailing address:
  • Phone: 608-222-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87530
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: