Healthcare Provider Details

I. General information

NPI: 1578428561
Provider Name (Legal Business Name): MICHELLE JANE LEE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S WHEATLAND AVE
SIOUX FALLS SD
57106-4742
US

IV. Provider business mailing address

1800 S WHEATLAND AVE
SIOUX FALLS SD
57106-4742
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax:
Mailing address:
  • Phone: 605-336-3230
  • Fax: 605-861-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberP007047
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: