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NPI Code Detail

MEDICARE: VIVIAN LEE

MEDICARE: VIVIAN LEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner7660MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17660OTHERMNBON

General Provider Information

NPI Number : 1124624945
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN LEE
Provider Business Mailing Address
First Line : 1040 GRAND AVE # 5161
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1040 GRAND AVE # 5161
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3001
Country : US
Telephone Number : 651-224-2155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2020
Last Update Date : 12/09/2020

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Directions to “ VIVIAN LEE ” Practice Location

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