Healthcare Provider Details

I. General information

NPI: 1154707503
Provider Name (Legal Business Name): JOEL LEE, RN B.S.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2015
Last Update Date: 08/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S COLLEGE ST APT. 228
NEWBERG OR
97132-3372
US

IV. Provider business mailing address

1210 S COLLEGE ST APT. 228
NEWBERG OR
97132-3372
US

V. Phone/Fax

Practice location:
  • Phone: 360-431-8332
  • Fax:
Mailing address:
  • Phone: 360-431-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number201500672RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: