Provider Demographics
NPI:1427094556
Name:LEE, ELEANOR RAYSHAN (PHD, ARNP)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:RAYSHAN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13891 SE 64TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4809
Mailing Address - Country:US
Mailing Address - Phone:206-954-0075
Mailing Address - Fax:425-643-9195
Practice Address - Street 1:13891 SE 64TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4809
Practice Address - Country:US
Practice Address - Phone:206-954-0075
Practice Address - Fax:425-643-9195
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007012363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30007012OtherARNP
WA9647868Medicaid
WARN00113301OtherRN
WARN00113301OtherRN
8859775Medicare PIN
WAAP30007012OtherARNP