Provider Demographics
NPI:1063477271
Name:LEE, RUBY RENAE (CRNA)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:RENAE
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8091 CENTERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-8428
Mailing Address - Country:US
Mailing Address - Phone:251-209-8735
Mailing Address - Fax:251-479-6737
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-344-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064412367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP80980Medicare UPIN
ALP80980Medicare UPIN