Provider Demographics
NPI:1063688299
Name:LEE, RENEE JEANNE (RN, NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:JEANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1234 E NORTH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4960
Mailing Address - Country:US
Mailing Address - Phone:209-824-2202
Mailing Address - Fax:209-824-2205
Practice Address - Street 1:1234 E NORTH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4960
Practice Address - Country:US
Practice Address - Phone:209-824-2202
Practice Address - Fax:209-824-2205
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA538100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily