MEDICARE: MRS. HEATHER LEE RN

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	163WC1500X	Community Health Registered Nurse	111522	CO

General Provider Information

NPI Number	:	1770798522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER LEE RN

Provider Business Mailing Address
First Line	:	410 HILL AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 HILL AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2528
Country	:	US
Telephone Number	:	970-254-5404
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	03/30/2012

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