Provider Demographics
NPI:1023204765
Name:LEE, DOROTHY SUSAN (NP)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:SUSAN
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 WASHINGTON AVE
Mailing Address - Street 2:UNIVERSITY CLINIC
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5756
Mailing Address - Country:US
Mailing Address - Phone:989-895-2035
Mailing Address - Fax:989-895-4014
Practice Address - Street 1:1200 WASHINGTON AVE
Practice Address - Street 2:UNIVERSITY CLINIC
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-1916
Practice Address - Country:US
Practice Address - Phone:989-895-2035
Practice Address - Fax:989-895-4014
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2017-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704172619363LA2200X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health