Individual
MRS. EMILY ANN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10400 75TH ST STE 215, KENOSHA, WI 53142-7884
(262) 948-7380
Mailing address
10400 75TH, STE 215, KENOSHA, WI 53142-8323
(262) 948-7380
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0800
SD
363A00000X
Physician Assistant
Primary
3731-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6837080
—
SD
Enumeration date
02/03/2012
Last updated
07/21/2022
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