Provider Demographics
NPI:1114996436
Name:LEE, MARIA IVONNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:IVONNE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2217
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-379-5512
Practice Address - Street 1:961 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2217
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-379-5512
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418256163WM0705X
CA8058363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology