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Individual
JODIE RAE LEE
Active
Individual
JODIE RAE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN,ARNP,CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
C-108517
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558696104
—
IA
01
—
175150080
MEDICARE
—
Enumeration date
10/14/2009
Last updated
02/24/2017
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