Provider Demographics
NPI:1861101222
Name:LEE, ANTOINETTE MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:MARIE
Other - Last Name:VITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:480 E ROOSEVELT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3969
Mailing Address - Country:US
Mailing Address - Phone:630-492-1965
Mailing Address - Fax:
Practice Address - Street 1:480 E ROOSEVELT RD STE 105
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3969
Practice Address - Country:US
Practice Address - Phone:630-492-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily