Provider Demographics
NPI:1043405798
Name:LAU LEE, JEANNIE W (PNP)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:W
Last Name:LAU LEE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E KATELLA AVE
Mailing Address - Street 2:SUITE M.
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5146
Mailing Address - Country:US
Mailing Address - Phone:714-633-7111
Mailing Address - Fax:714-633-2903
Practice Address - Street 1:1920 E KATELLA AVE
Practice Address - Street 2:SUITE M.
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5146
Practice Address - Country:US
Practice Address - Phone:714-633-7111
Practice Address - Fax:714-633-2903
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner