MEDICARE: JOANNA LEE COMMONS RNBC, NP-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	363LF0000X	Family Nurse Practitioner	28079503A	IN

General Provider Information

NPI Number	:	1548201940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LEE COMMONS RNBC, NP-C

Provider Business Mailing Address
First Line	:	4540 W 3RD ST
Second Line	:
City	:	WEST LEBANON
State	:	IN
Zip	:	47991-8089
Country	:	US
Telephone Number	:	765-893-4299
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 W US HIGHWAY 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9770
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:	612-659-7101

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/13/2009

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