MEDICARE: CHRISTINE LEE APN, FNP-BC

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	209.012029	IL

General Provider Information

NPI Number	:	1972993434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LEE APN, FNP-BC

Provider Business Mailing Address
First Line	:	4220 W 95TH ST
Second Line	:	SUITE 200
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2793
Country	:	US
Telephone Number	:	708-876-1550
Fax Number	:	708-876-1551

Provider Business Practice Location Address
First Line	:	4220 W 95TH ST
Second Line	:	SUITE 200
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2793
Country	:	US
Telephone Number	:	708-876-1550
Fax Number	:	708-876-1551

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

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	03/31/2021

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