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NPI Code Detail

MEDICARE: MS. JADE LEE CRNP

MEDICARE: MS. JADE LEE CRNP
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
1163W00000XRegistered NurseRN556188PA
2363LF0000XFamily Nurse PractitionerSP015890PA

General Provider Information

NPI Number : 1891153235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JADE LEE CRNP
Provider Business Mailing Address
First Line : 1472 MCKINLEY ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-2705
Country : US
Telephone Number : 267-257-0093
Fax Number :
Provider Business Practice Location Address
First Line : 515 W CHELTEN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19144-4414
Country : US
Telephone Number : 215-848-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2016
Last Update Date : 01/31/2016

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