MEDICARE: KHAMPHAI LEE DNP-FNP

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	363LF0000X	Family Nurse Practitioner	17854-33	WI

General Provider Information

NPI Number	:	1780532630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHAMPHAI LEE DNP-FNP

Provider Business Mailing Address
First Line	:	1676 MAIN ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-2636
Country	:	US
Telephone Number	:	920-327-1565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1676 MAIN ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-2636
Country	:	US
Telephone Number	:	920-327-1565
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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