Healthcare Provider Details

I. General information

NPI: 1750994372
Provider Name (Legal Business Name): ROSALYN LEE R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CROTHER RD
MEADOW VISTA CA
95722-9431
US

IV. Provider business mailing address

4061 MARCELLA DR
AUBURN CA
95602-9515
US

V. Phone/Fax

Practice location:
  • Phone: 530-878-8720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number843506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: