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Individual

MRS. LAURA P LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3101 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 366-6162
(217) 366-5642
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-6162
(217) 366-5642

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-002082
IL
363AM0700X
Medical Physician Assistant
Primary
085-02082
IL
363AM0700X
Medical Physician Assistant
Primary
085002082
IL

Other

Enumeration date
10/28/2005
Last updated
04/28/2026
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