| NPI | 1871602334 |
|---|---|
| Former Name | TERESA JO LEE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2002031633) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-12-17 |