Provider Demographics
NPI:1114546215
Name:FEE, ANNISSA AZALEA
Entity Type:Individual
Prefix:
First Name:ANNISSA
Middle Name:AZALEA
Last Name:FEE
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 1:925 PATRICK PL
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1455
Mailing Address - Country:US
Mailing Address - Phone:330-621-3073
Mailing Address - Fax:
Practice Address - Street 1:1 S GROVE ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2004
Practice Address - Country:US
Practice Address - Phone:614-823-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program