Provider Demographics
NPI:1073914628
Name:LEE, MARCHELLE DIANE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:MARCHELLE
Middle Name:DIANE
Last Name:LEE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:MARCHELLE
Other - Middle Name:DIANE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:21110 MANDARIN GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-7540
Mailing Address - Country:US
Mailing Address - Phone:832-233-4472
Mailing Address - Fax:281-656-4401
Practice Address - Street 1:21110 MANDARIN GLEN CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-7540
Practice Address - Country:US
Practice Address - Phone:832-233-4472
Practice Address - Fax:281-656-4401
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698549163W00000X, 163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health