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NPI Code Detail

MEDICARE: ANNA LAVETTE LEE

MEDICARE: ANNA LAVETTE 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1110946AZ

General Provider Information

NPI Number : 1801594890
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA LAVETTE LEE
Provider Business Mailing Address
First Line : 2105 N CITRUS RD
Second Line :
City : GOODYEAR
State : AZ
Zip : 85395-9204
Country : US
Telephone Number : 330-209-7586
Fax Number :
Provider Business Practice Location Address
First Line : 2105 N CITRUS RD
Second Line :
City : GOODYEAR
State : AZ
Zip : 85395-9204
Country : US
Telephone Number : 623-853-0304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2023
Last Update Date : 02/23/2023

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Directions to “ ANNA LAVETTE LEE ” Practice Location

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