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General NPI Number Information
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NPI Number | 1417532276
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Entity Type | Individual
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Provider Name | MIKI CHU LAM LEE RN, CDCES
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Gender | Female
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Dates
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Enumeration Date | 03/13/2021
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 3900 TELEPORT BLVD UNIT 140063
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City | IRVING
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State | TX
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Zip | 75014-0017
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Country | US
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Telephone | 312-933-0671
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 140063
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City | IRVING
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State | TX
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Zip | 75014-0063
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Country | US
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Telephone | 312-933-0761
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 041410077
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 267957
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License Number State | AZ
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