Basic Information
| Provider Information | |||||||||
| NPI: | 1346562212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | ARNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 N.W/ 167TH STREET | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331696930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7868704039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1712 EAST BROAD STREET | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043449848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2010 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 0024164573 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.