Provider Demographics
NPI:1104962323
Name:LEE, CAROLINE ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2157 GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-2203
Mailing Address - Country:US
Mailing Address - Phone:610-670-0098
Mailing Address - Fax:610-685-1567
Practice Address - Street 1:740 PENN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19610-6065
Practice Address - Country:US
Practice Address - Phone:610-376-3700
Practice Address - Fax:610-685-1567
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003103G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology