Lee McDonald Defazio, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP009466 Issued in PA

Practice address

62 Industrial Park Rd
Lake Ariel, PA 18436-5606

Phone

(570) 689-7565

Fax

(570) 689-4803

NPI assigned

Oct 19, 2007

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Delta Medix PC

  • Legal Medicine
  • Scranton, PA
  • NPI 1396701876
  Medicare reassignment NPD
• Wayne Memorial Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Honesdale, PA
  • NPI 1952395121
  Medicare reassignment NPD
• Wayne Memorial Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Honesdale, PA
  • NPI 1346000569
  NPD
• Pediatric Practices of Northeastern PA

  • Pediatrics Physician
  • Milford, PA
  • NPI 1861722902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1346439981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1837 FAIR AVE",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184312121",
            "telephone_number": "570-253-5838",
            "fax_number": "570-253-6678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 INDUSTRIAL PARK RD",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184365606",
            "telephone_number": "570-689-7565",
            "fax_number": "570-689-4803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1837 Fair Ave",
            "address_purpose": "LOCATION",
            "city": "Honesdale",
            "state": "PA",
            "postal_code": "184312121",
            "country_code": "US",
            "telephone_number": "570-253-5838 x124",
            "fax_number": "570-253-6678",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27B Woodlands Dr",
            "address_purpose": "LOCATION",
            "city": "Waymart",
            "state": "PA",
            "postal_code": "184729366",
            "country_code": "US",
            "telephone_number": "570-488-9550",
            "fax_number": "570-488-9553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Route 6 and 209 Ste 103",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "PA",
            "postal_code": "183377615",
            "country_code": "US",
            "telephone_number": "570-296-4901",
            "fax_number": "570-296-5480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEFAZIO",
        "first_name": "LEE",
        "middle_name": "MCDONALD",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP009466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025941780002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025941780003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025941780001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025941780004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph John Brogenski Jr., RPH
• Amanda Burnside, MA, ATR-BC, LPC
• Bridgette Denise Cannella, RD, LDN
• Heather Chapman, RPH
• Richard Chowanec, OTA/L
• Devereux Foundation
• Christina Anne Dicarlo, MA, LPC, LCADC
• Tamara Ann Dobrzyn
• Julia Emmett
• Family First Vision Center, Inc

• Family Nurse Practitioner in Lake Ariel, PA
• Providers in Lake Ariel, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.