Provider Demographics
NPI:1114455698
Name:LEE, CARLENE ANITA
Entity Type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:ANITA
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 1:808 HAYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-2322
Mailing Address - Country:US
Mailing Address - Phone:757-383-3491
Mailing Address - Fax:252-652-8356
Practice Address - Street 1:808 HAYWOOD PL
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-2322
Practice Address - Country:US
Practice Address - Phone:757-383-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30-013-4262OtherNEMT