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General NPI Number Information
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NPI Number | 1528496767
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Entity Type | Organization
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Legal Business Name | J.P. LEE, LLC
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 425 N OAK ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-3764
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Country | US
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Telephone | 308-532-8300
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Fax | 308-532-4629
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Provider Business Mailing Address
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Address Line | 425 N OAK ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-3764
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Country | US
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Telephone | 308-532-8300
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Fax | 308-532-4629
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Authorized Official
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Title or Position | PROVISIONAL
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Name | WENDY L HAGEMAN
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Credential | PLMHP
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Telephone | 308-532-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10101
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License Number State | NE
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