Basic Information
| Provider Information | |||||||||
| NPI: | 1790872679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | V. | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 HARDING HWY | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458043433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192212821 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2727 HARDING HWY | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458043433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192212821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | APRN.CNS.06175 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 251S00000X | N | Agencies | Community/Behavioral Health |
No ID Information.