Individual
MRS. ANN C LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 285-5531
Mailing address
417 N BRINTON AVE, DIXON, IL 61021-2129
(815) 440-5039
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209019542
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209019542
STATE LICENSE
IL
Enumeration date
08/30/2019
Last updated
08/30/2019
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