Healthcare Provider Details

I. General information

NPI: 1497205884
Provider Name (Legal Business Name): YOOMI LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 CORLISS LN
COLEBROOK NH
03576-3206
US

IV. Provider business mailing address

141 CORLISS LANE
COLEBROOK NH
03576-3206
US

V. Phone/Fax

Practice location:
  • Phone: 603-237-8336
  • Fax: 603-237-4467
Mailing address:
  • Phone: 603-237-8336
  • Fax: 603-237-4467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number064054-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number72982
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: