MEDICARE: MS. CORY ANN LEE MA

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	171M00000X	Case Manager/Care Coordinator		NM

General Provider Information

NPI Number	:	1881992998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORY ANN LEE MA

Provider Business Mailing Address
First Line	:	640 GROVE ST SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-4063
Country	:	US
Telephone Number	:	505-266-0110
Fax Number	:	505-266-0998

Provider Business Practice Location Address
First Line	:	640 GROVE ST SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-4063
Country	:	US
Telephone Number	:	505-266-0110
Fax Number	:	505-266-0998

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

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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