MEDICARE: STEPHANIE M 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
1	251J00000X	Nursing Care Agency	RN305977	OH
2	251E00000X	Home Health Agency	1820930	OH

General Provider Information

NPI Number	:	1134364979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE M LEE

Provider Business Mailing Address
First Line	:	4083 SASSAFRAS CT
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-9678
Country	:	US
Telephone Number	:	614-378-6980
Fax Number	:	614-875-0240

Provider Business Practice Location Address
First Line	:	4083 SASSAFRAS CT
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-9678
Country	:	US
Telephone Number	:	614-378-5980
Fax Number	:	614-875-0240

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	STEPHANIE MICHELLE LEE
Credential	:	RN
Telephone Number	:	614-378-5980

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	12/31/2008

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