Provider Demographics
NPI:1083729305
Name:LEE, JULIE ERICA
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ERICA
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 1:1793 N CROSSBERRY CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2446
Mailing Address - Country:US
Mailing Address - Phone:913-680-9502
Mailing Address - Fax:
Practice Address - Street 1:1793 N CROSSBERRY CV
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2446
Practice Address - Country:US
Practice Address - Phone:913-680-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000115712163WC1500X
TN34718364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health