Provider Demographics
NPI:1114428166
Name:LEE, RACHEAL
Entity Type:Individual
Prefix:
First Name:RACHEAL
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 1:107 EDWARDS HILL RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:NY
Mailing Address - Zip Code:13797-1735
Mailing Address - Country:US
Mailing Address - Phone:607-760-6801
Mailing Address - Fax:
Practice Address - Street 1:107 EDWARDS HILL RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:NY
Practice Address - Zip Code:13797-1735
Practice Address - Country:US
Practice Address - Phone:607-760-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565213-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse