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General NPI Number Information
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NPI Number | 1801164363
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Entity Type | Individual
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Provider Name | ROBERT W LEE II ACNP, RN
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Gender | Male
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 6051 U S HIGHWAY 49
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City | HATTIESBURG
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State | MS
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Zip | 39401-7200
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Country | US
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Telephone | 800-494-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 W 4TH ST
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City | HATTIESBURG
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State | MS
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Zip | 39402-1000
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Country | US
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Telephone | 800-494-8260
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R869297
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License Number State | MS
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