Provider Demographics
NPI:1013206572
Name:KLEE, ELLEN DIANA (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:DIANA
Last Name:KLEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GOVERNORS AVE
Mailing Address - Street 2:LAWRENCE MEMORIAL HOSPITAL-DIABETES CENTER
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-306-6370
Mailing Address - Fax:781-306-6375
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:LAWRENCE MEMORIAL HOSPITAL-DIABETES CENTER
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6370
Practice Address - Fax:781-306-6375
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265967363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health