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Individual

MR. JESSE NEWTON LEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1900 EXETER RD, GERMANTOWN, TN 38138-2954
(901) 818-2160
Mailing address
1900 EXETER RD, GERMANTOWN, TN 38138-2954
(901) 818-2160

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
190871
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
17054
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02509086
MS
01
1023360260
CHAMPUS/TRICARE
05
12497024
TN
05
195879003
AR
01
4338105
BCBST
TN
Enumeration date
10/12/2012
Last updated
04/10/2013
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