Provider Demographics
NPI:1134655897
Name:LEE, MOLLY (FAMILY NURSE PRACTIO)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIO
Other - Prefix:MRS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:BY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:903 E. DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-929-1611
Mailing Address - Fax:951-929-5311
Practice Address - Street 1:255 N WHITE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1966
Practice Address - Country:US
Practice Address - Phone:408-503-7600
Practice Address - Fax:408-503-7650
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily