Active NPI
Song Lee, FNP-C
- Family Nurse Practitioner
- Blaine, MN
National Provider Identifier
1871969147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 8018
- Practice address
- 2357 108TH LN NE
Blaine, MN 55449-5222 - Phone
- (866) 389-2727
- NPI assigned
- Aug 20, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2015029823 | MO | |
| Family Nurse Practitioner | 363LF0000X | 8018 | MN | Primary |
| Family Nurse Practitioner | 363LF0000X | 21056 | TN |
Addresses
Primary practice location
2357 108TH LN NE
Blaine, MN 55449-5222
Mailing address
2357 108TH LN NE
Blaine, MN 55449-5222
Phone (866) 389-2727
Other practice location 1
6670 Stage Rd
Bartlett, TN 38134-3810
Phone (866) 389-2727
Other practice location 2
2115 Union Ave
Memphis, TN 38104-4233
Phone (866) 389-2727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8018 | MN | MD | Physical Therapist |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615248000000",
"number": "1871969147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2357 108TH LN NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554495222",
"telephone_number": "866-389-2727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2357 108TH LN NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554495222",
"telephone_number": "866-389-2727"
}
],
"practiceLocations": [
{
"address_1": "6670 Stage Rd",
"address_purpose": "LOCATION",
"city": "Bartlett",
"state": "TN",
"postal_code": "381343810",
"country_code": "US",
"telephone_number": "866-389-2727",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2115 Union Ave",
"address_purpose": "LOCATION",
"city": "Memphis",
"state": "TN",
"postal_code": "381044233",
"country_code": "US",
"telephone_number": "866-389-2727",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "SONG",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-20",
"last_updated": "2021-03-09",
"certification_date": "2021-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2015029823",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "8018",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "21056",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.