Healthcare Provider Details

I. General information

NPI: 1700603297
Provider Name (Legal Business Name): PAULETTA CHIEF-LEE MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTE N12 AND N7
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8431
  • Fax: 928-729-3355
Mailing address:
  • Phone: 928-729-8431
  • Fax: 928-729-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNDP-2024-0141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: