MEDICARE: EUNJEONG ANNA LEE MS, APRN-CNP, AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.518724	OH
2	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0037055	OH

General Provider Information

NPI Number	:	1013777606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNJEONG ANNA LEE MS, APRN-CNP, AGNP-C

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N PICKAWAY ST STE 102
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1447
Country	:	US
Telephone Number	:	740-420-8174
Fax Number	:	740-420-8185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	05/11/2026

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