Provider Demographics
NPI:1699510941
Name:LEE FATT, CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LEE FATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N RIVER RD STE 220
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1297
Mailing Address - Country:US
Mailing Address - Phone:847-487-2827
Mailing Address - Fax:847-487-2860
Practice Address - Street 1:150 N RIVER RD STE 220
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1297
Practice Address - Country:US
Practice Address - Phone:847-487-2827
Practice Address - Fax:847-487-2860
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant