Provider Demographics
NPI:1093464703
Name:LEE, JOANNA JULIA
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:JULIA
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 1:3706 LLANO ESTACADO CT
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3913
Mailing Address - Country:US
Mailing Address - Phone:254-462-2693
Mailing Address - Fax:
Practice Address - Street 1:402 W RANCIER AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-3243
Practice Address - Country:US
Practice Address - Phone:254-462-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health