Provider Demographics
NPI:1871571612
Name:LEE, PRISCILLA ANNE (NP)
Entity type:Individual
Prefix:PROF
First Name:PRISCILLA
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5016
Mailing Address - Country:US
Mailing Address - Phone:805-499-5373
Mailing Address - Fax:805-499-5373
Practice Address - Street 1:3378 DANIEL ST
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5016
Practice Address - Country:US
Practice Address - Phone:805-499-5373
Practice Address - Fax:805-499-5373
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3592363LF0000X
CANP 3592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871571612Medicaid
CAWNP3592COtherMEMBER ID
CAHF674YMedicare PIN
CA1871571612Medicaid
CAWNP3592COtherMEMBER ID