MEDICARE: JANE LEE

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	363LP2300X	Primary Care Nurse Practitioner	312487	NY

General Provider Information

NPI Number	:	1306727730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE LEE

Provider Business Mailing Address
First Line	:	13111 FOWLER AVE APT 4L
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-4983
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 150TH PL
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4922
Country	:	US
Telephone Number	:	347-368-6691
Fax Number	:

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

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/14/2025

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