Provider Demographics
NPI:1083493548
Name:LEE, LAVERNE
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:
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 1:3393 BLAINE ST NE APT 3D
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1377
Mailing Address - Country:US
Mailing Address - Phone:202-760-8573
Mailing Address - Fax:
Practice Address - Street 1:2850 DOUGLASS PL SE APT 314
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4498
Practice Address - Country:US
Practice Address - Phone:240-472-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant