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General NPI Number Information
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NPI Number | 1790784189
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Entity Type | Individual
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Provider Name | JOAN DENISE LEE CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 530 S JACKSON ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1675
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Country | US
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Telephone | 502-852-5851
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Fax | 502-852-3762
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Provider Business Mailing Address
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Address Line | 20 MEDICAL VILLAGE DR SUITE 208
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City | EDGEWOOD
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State | KY
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Zip | 41017-5401
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Country | US
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Telephone | 859-344-2211
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Fax | 859-344-2511
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 042255
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3007567
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License Number State | KY
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