Provider Demographics
NPI:1104545177
Name:LEE, CLAIRE (FNP)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 HOLLY LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2226
Mailing Address - Country:US
Mailing Address - Phone:703-712-0700
Mailing Address - Fax:
Practice Address - Street 1:1500 CORNERSIDE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2439
Practice Address - Country:US
Practice Address - Phone:703-740-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001280634163W00000X
VA0024184869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024184869OtherFNP LICENSE