Basic Information
| Provider Information | |||||||||
| NPI: | 1063168268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | AGNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1315 TOWER RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE HOCKING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457425267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408188579 | ||||||||
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| Practice Location | |||||||||
| Address1: | 803 FARSON ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457140016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404233640 | ||||||||
| FaxNumber: | 7404233641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | AGNP.CNP.0030870 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.