Healthcare Provider Details

I. General information

NPI: 1275250763
Provider Name (Legal Business Name): LAWANA DENISE LEE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2399
US

IV. Provider business mailing address

12689 STONERIDGE LN APT 204
SOUTH ROCKWOOD MI
48179-9545
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-7100
  • Fax:
Mailing address:
  • Phone: 734-652-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704252063
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: