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General NPI Number Information
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NPI Number | 1619518453
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Entity Type | Individual
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Provider Name | THERESA CAROL LEE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 420 GRAND AVE STE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4141
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Country | US
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Telephone | 201-569-7044
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Fax |
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Provider Business Mailing Address
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Address Line | 333 WILLOW ST APT 404
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City | TEANECK
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State | NJ
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Zip | 07666-4068
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Country | US
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Telephone | 847-877-6172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00967900
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License Number State | NJ
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