Healthcare Provider Details

I. General information

NPI: 1730425943
Provider Name (Legal Business Name): NANTAWADEE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64030 HIGHWAY 434
LACOMBE LA
70445-3456
US

IV. Provider business mailing address

64030 HWY 434
LACOMBE LA
70445
US

V. Phone/Fax

Practice location:
  • Phone: 985-690-7500
  • Fax:
Mailing address:
  • Phone: 985-690-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number363LA2100X
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163W00000X
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: