Basic Information
| Provider Information | |||||||||
| NPI: | 1306194733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | I-CHIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | ANP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY DRIVE C | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123606000 | ||||||||
| FaxNumber: | 4123606290 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY DRIVE C | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123606000 | ||||||||
| FaxNumber: | 4123606290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 07/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN1022186 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | R199927 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | SP017544 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.