Individual
JESSICA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
36000 EUCLID AVE, WILLOUGHBY, OH 44094-4625
(440) 350-0832
(440) 354-7420
Mailing address
7757 AUBURN RD STE 15, PAINESVILLE, OH 44077-9604
(440) 350-0832
(440) 354-7420
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67.000175
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3142950
—
OH
01
—
P01168482
MEDICARE RAILROAD
OH
Enumeration date
04/28/2010
Last updated
02/28/2020
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