Provider Demographics
NPI:1447504998
Name:LEE, JENNIFER YOUDUK (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YOUDUK
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ROE ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-2819
Mailing Address - Country:US
Mailing Address - Phone:253-507-2780
Mailing Address - Fax:253-212-0779
Practice Address - Street 1:505 ROE ST
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-2819
Practice Address - Country:US
Practice Address - Phone:253-507-2780
Practice Address - Fax:253-212-0779
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00146936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse