MEDICARE: JEAN M. LEE ARNP

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	363L00000X	Nurse Practitioner	AP30004078	WA
2	363LA2200X	Adult Health Nurse Practitioner	AP30004078	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82834U	OTHER	WA	REGENCE BLUE SHIELD PIN
2	0155100	OTHER	WA	L&I PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427082007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M. LEE ARNP

Provider Business Mailing Address
First Line	:	901 BOREN AVE
Second Line	:	SUITE 1320
City	:	SEATTLE
State	:	WA
Zip	:	98104-3595
Country	:	US
Telephone Number	:	206-667-2398
Fax Number	:	206-667-2299

Provider Business Practice Location Address
First Line	:	901 BOREN AVE
Second Line	:	SUITE 1320
City	:	SEATTLE
State	:	WA
Zip	:	98104-3595
Country	:	US
Telephone Number	:	206-667-2398
Fax Number	:	206-667-2299

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/16/2009

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