Provider Demographics
NPI:1932648706
Name:LEE, ADA CHUKKWAN (NP)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:CHUKKWAN
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SILVER BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2384
Mailing Address - Country:US
Mailing Address - Phone:917-915-8506
Mailing Address - Fax:
Practice Address - Street 1:2600 GLASGOW AVE STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5704
Practice Address - Country:US
Practice Address - Phone:302-204-1639
Practice Address - Fax:302-209-6927
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0010414363LP2300X, 363LG0600X
NYF307989-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology