=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700848629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA DELORES LEE CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 07/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2401 S 67TH STREET JOHN BARTRAM HIGH SCHOOL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-492-6450
-----------------------------------------------------
Fax | 215-492-2324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1039 YEADON AVENUE
-----------------------------------------------------
City | YEADON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-626-7419
-----------------------------------------------------
Fax | 610-626-5683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN214902L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP005013B
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------