MEDICARE: JESSICA LEE NP

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	95005-65	CA

General Provider Information

NPI Number	:	1528517083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEE NP

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 403
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3905
Country	:	US
Telephone Number	:	213-250-9988
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	12/29/2025

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