Individual
GRACE LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
5030 BROADWAY, NEW YORK, NY 10034-1609
(718) 412-3445
Mailing address
5030 BROADWAY, NEW YORK, NY 10034-1609
(718) 412-3445
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
311775
NY
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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