Basic Information
Provider Information
NPI: 1811487093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: ANNE
MiddleName: MERRIMAN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1661 E CAMELBACK RD STE 200
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850163913
CountryCode: US
TelephoneNumber: 6022411671
FaxNumber:  
Practice Location
Address1: 1661 E CAMELBACK RD STE 160
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850163921
CountryCode: US
TelephoneNumber: 6022411671
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2018
LastUpdateDate: 06/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X65845AZY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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