Healthcare Provider Details

I. General information

NPI: 1932793528
Provider Name (Legal Business Name): HYUNHWA LEE PHD, MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. HENNA LEE

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CANDLEWYCK DR
HENDERSON NV
89052-6654
US

IV. Provider business mailing address

21 CANDLEWYCK DR
HENDERSON NV
89052-6654
US

V. Phone/Fax

Practice location:
  • Phone: 734-717-1069
  • Fax:
Mailing address:
  • Phone: 734-717-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001833
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80700
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: