Healthcare Provider Details

I. General information

NPI: 1336609726
Provider Name (Legal Business Name): SONYONG A LEE MSN, APRN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19284 STONE OAK PKWY STE 102
SAN ANTONIO TX
78258-3474
US

IV. Provider business mailing address

19284 STONE OAK PKWY STE 102
SAN ANTONIO TX
78258-3474
US

V. Phone/Fax

Practice location:
  • Phone: 210-246-0124
  • Fax: 210-246-0146
Mailing address:
  • Phone: 210-268-0124
  • Fax: 210-268-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP141072
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: