Provider Demographics
NPI:1548688013
Name:JANSSEN, LEE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-9100
Mailing Address - Country:US
Mailing Address - Phone:850-866-4130
Mailing Address - Fax:
Practice Address - Street 1:1004 HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-9100
Practice Address - Country:US
Practice Address - Phone:850-866-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman