=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104966837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET TYCER LEE RN, MSN, ANP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15481 W CLUB DELUXE RD S. TANGIPAHOA PARISH HEALTH UNIT
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-543-4170
-----------------------------------------------------
Fax | 985-543-4171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1224 HIGHWAY 1046 P.O. BOX 156
-----------------------------------------------------
City | AMITE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70422-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-748-7727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN045429 AP03479
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------