Healthcare Provider Details

I. General information

NPI: 1548654213
Provider Name (Legal Business Name): STEPHANIE K LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 S 91ST ST
LINCOLN NE
68526-9797
US

IV. Provider business mailing address

2000 Q ST STE 500
LINCOLN NE
68503-3610
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-6555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1970
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number076997
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: