Healthcare Provider Details

I. General information

NPI: 1346832441
Provider Name (Legal Business Name): LEE ALEXIS MCKEEVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 THOMAS JOHNSON DR STE H
FREDERICK MD
21702-4893
US

IV. Provider business mailing address

818 PHILADELPHIA AVE
SILVER SPRING MD
20910-4936
US

V. Phone/Fax

Practice location:
  • Phone: 301-414-2300
  • Fax:
Mailing address:
  • Phone: 440-935-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR196117
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR196117
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: