Provider Demographics
NPI:1033991641
Name:LEE, KATHERINE L
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1320
Mailing Address - Country:US
Mailing Address - Phone:440-510-7575
Mailing Address - Fax:
Practice Address - Street 1:4937 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1320
Practice Address - Country:US
Practice Address - Phone:440-510-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide