MEDICARE: MS. EMILY SHOUA LEE ADN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95289919	CA

General Provider Information

NPI Number	:	1649135187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY SHOUA LEE ADN, RN

Provider Business Mailing Address
First Line	:	101 CREEKSIDE RIDGE CT # 215
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3595
Country	:	US
Telephone Number	:	916-659-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CREEKSIDE RIDGE CT # 215
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3595
Country	:	US
Telephone Number	:	916-659-0003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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