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NPI Code Detail

MEDICARE: SANDRA MICHELLE LEE MSN, FNP-BC

MEDICARE: SANDRA MICHELLE LEE MSN, FNP-BC
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
1363LF0000XFamily Nurse Practitioner4704272995MI
2363LF0000XFamily Nurse Practitioner71011974AIN

General Provider Information

NPI Number : 1780358457
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA MICHELLE LEE MSN, FNP-BC
Provider Business Mailing Address
First Line : 20450 PEARL ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-5253
Country : US
Telephone Number : 360-921-7004
Fax Number :
Provider Business Practice Location Address
First Line : 4501 LINCOLNWAY E
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-4035
Country : US
Telephone Number : 574-255-4729
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2021
Last Update Date : 12/10/2021

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