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General NPI Number Information
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NPI Number | 1952717670
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Entity Type | Individual
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Provider Name | EUN JEONG LEE NP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 3104 PONTE MORINO DR STE 110
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City | CAMERON PARK
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State | CA
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Zip | 95682-8282
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Country | US
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Telephone | 530-621-7700
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Fax | 530-621-7713
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Provider Business Mailing Address
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Address Line | 11594 BIG FOUR WAY
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City | GOLD RIVER
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State | CA
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Zip | 95670-8211
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Country | US
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Telephone | 530-510-3314
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95000614
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License Number State | CA
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