MEDICARE: NICHOLE LEE NP

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	163WX0200X	Oncology Registered Nurse	RN161542	AZ
2	363L00000X	Nurse Practitioner	235410	AZ
3	363LA2100X	Acute Care Nurse Practitioner	235410	AZ

General Provider Information

NPI Number	:	1609419639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE LEE NP

Provider Business Mailing Address
First Line	:	13504 N 154TH LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-9160
Country	:	US
Telephone Number	:	623-262-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 W THUNDERBIRD RD STE C300
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4666
Country	:	US
Telephone Number	:	623-238-7490
Fax Number	:

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

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	11/24/2023

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Directions to “ NICHOLE LEE NP” Practice Location

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