Provider Demographics
NPI:1134307572
Name:LEE, ADESUWA (RN, BSN, FNP)
Entity Type:Individual
Prefix:
First Name:ADESUWA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RN, BSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1808
Mailing Address - Country:US
Mailing Address - Phone:781-635-2005
Mailing Address - Fax:781-885-0084
Practice Address - Street 1:67 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1817
Practice Address - Country:US
Practice Address - Phone:781-635-2005
Practice Address - Fax:781-885-0084
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN204949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily