MEDICARE: MRS. NAOMI DIANA LEE LICENSED PRACTICAL N

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	164W00000X	Licensed Practical Nurse	4703093935	MI

General Provider Information

NPI Number	:	1144612375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAOMI DIANA LEE LICENSED PRACTICAL N

Provider Business Mailing Address
First Line	:	2962 CHERRY CREEK LN
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1021
Country	:	US
Telephone Number	:	586-227-7422
Fax Number	:

Provider Business Practice Location Address
First Line	:	2962 CHERRY CREEK LN
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1021
Country	:	US
Telephone Number	:	586-227-7422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	01/23/2026

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