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NPI Code Detail

MEDICARE: AMANDA M. LEE MSN, PNP-BC

MEDICARE: AMANDA M. LEE MSN, PNP-BC
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
1363LP0200XPediatric Nurse Practitioner209009815IL

General Provider Information

NPI Number : 1356695043
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA M. LEE MSN, PNP-BC
Provider Business Mailing Address
First Line : 1817 S LOOMIS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3018
Country : US
Telephone Number : 312-666-6511
Fax Number : 312-666-1658
Provider Business Practice Location Address
First Line : 1817 S LOOMIS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3018
Country : US
Telephone Number : 312-666-6511
Fax Number : 312-666-1658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2012
Last Update Date : 01/14/2013

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