Provider Demographics
NPI:1558653139
Name:LEE, WHAYOUN (APN-BC)
Entity type:Individual
Prefix:MRS
First Name:WHAYOUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:MS
Other - First Name:WHAYOUN
Other - Middle Name:
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4932 W LAWRENCE AVE APT H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3833
Mailing Address - Country:US
Mailing Address - Phone:773-725-8425
Mailing Address - Fax:
Practice Address - Street 1:4932 W LAWRENCE AVE APT H
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3833
Practice Address - Country:US
Practice Address - Phone:773-725-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008826363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care