Healthcare Provider Details

I. General information

NPI: 1518959295
Provider Name (Legal Business Name): BONNIE JEAN LEES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE STREET CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE STREET
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-6140
  • Fax: 402-955-3398
Mailing address:
  • Phone: 402-955-6140
  • Fax: 402-955-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number14359
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number38163
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4680
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number9568
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number30574
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number47431
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2005021462
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0430574
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0430574
License Number StateKS
# 10
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25692
License Number StateNE
# 11
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number31185
License Number StateZZ
# 12
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number23313
License Number StateCT
# 13
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number12091
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: