MEDICARE: ERVIN D. 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	3747A0650X	Attendant Care Provider		NV

General Provider Information

NPI Number	:	1376490797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERVIN D. LEE

Provider Business Mailing Address
First Line	:	80 S GIBSON RD APT 1211
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2437
Country	:	US
Telephone Number	:	702-855-3382
Fax Number	:	702-855-3384

Provider Business Practice Location Address
First Line	:	80 S GIBSON RD APT 1211
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2437
Country	:	US
Telephone Number	:	702-855-3382
Fax Number	:	702-855-3384

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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