Provider Demographics
NPI:1447247655
Name:LEE, LINDA I (FNP, PA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:LEE
Suffix:I
Gender:F
Credentials:FNP, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19021 US HIGHWAY 285
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-9410
Mailing Address - Country:US
Mailing Address - Phone:719-274-5121
Mailing Address - Fax:
Practice Address - Street 1:19021 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-9410
Practice Address - Country:US
Practice Address - Phone:719-274-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431047363L00000X
CO125926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19054751Medicaid
CAAP242ZMedicare PIN
CO274095YPYJMedicare PIN