Provider Demographics
NPI:1194721761
Name:LEE, JANET ANN (CRNA)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12116 SERENITY LANE
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1324
Mailing Address - Country:US
Mailing Address - Phone:410-442-0126
Mailing Address - Fax:
Practice Address - Street 1:12116 SERENITY LANE
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1324
Practice Address - Country:US
Practice Address - Phone:410-442-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR112035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS338OtherBC AND BS
MD454MH789OtherTRAILBLAZER
MD642700600Medicaid
MDNBO4JAOtherBC AND BS
MD642700600Medicaid
MDS338OtherBC AND BS