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NPI Code Detail

MEDICARE: JESSICA L LEES CRNA

MEDICARE:   JESSICA L LEES  CRNA
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
1367500000XCertified Registered Nurse AnesthetistCOA.00528-NAOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871588384
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA L LEES CRNA
Provider Business Mailing Address
First Line : PO BOX 74751
Second Line :
City : CLEVELAND
State : OH
Zip : 44194-0834
Country : US
Telephone Number : 440-997-2262
Fax Number :
Provider Business Practice Location Address
First Line : 2420 LAKE AVE
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-4954
Country : US
Telephone Number : 440-997-2262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 11/24/2014

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