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NPI Code Detail

MEDICARE: MS. NICOLE LEE

MEDICARE: MS. NICOLE 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1306081617
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE LEE
Provider Business Mailing Address
First Line : PO BOX 560
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95611-0560
Country : US
Telephone Number : 916-338-1001
Fax Number : 916-338-1044
Provider Business Practice Location Address
First Line : 5240 JACKSON ST
Second Line :
City : NORTH HIGHLANDS
State : CA
Zip : 95660-5003
Country : US
Telephone Number : 916-338-1001
Fax Number : 916-338-1044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2008
Last Update Date : 12/16/2008

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