Healthcare Provider Details

I. General information

NPI: 1215852272
Provider Name (Legal Business Name): LOUELLIYN MARIA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 E TWELVE OAKS DR
FLAGSTAFF AZ
86005-7062
US

IV. Provider business mailing address

474 E TWELVE OAKS DR
FLAGSTAFF AZ
86005-7062
US

V. Phone/Fax

Practice location:
  • Phone: 760-213-9136
  • Fax:
Mailing address:
  • Phone: 760-213-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number337822
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: