Provider Demographics
NPI:1083732218
Name:LEE, ROBERT EDWIN (CRNFA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWIN
Last Name:LEE
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-5412
Mailing Address - Country:US
Mailing Address - Phone:707-252-7019
Mailing Address - Fax:707-255-8047
Practice Address - Street 1:1361 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-5412
Practice Address - Country:US
Practice Address - Phone:707-252-7019
Practice Address - Fax:707-255-8047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308486163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant