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General NPI Number Information
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NPI Number | 1427866383
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Entity Type | Individual
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Provider Name | KENNETH ANDREW LEE RN
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Gender | Male
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Dates
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Enumeration Date | 12/24/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 2472 S 300 E
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84115-2895
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Country | US
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Telephone | 801-466-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 1895 S MCCLELLAND ST APT 4
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-3435
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Country | US
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Telephone | 435-922-5943
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 14184238-3102
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License Number State | UT
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