Provider Demographics
NPI:1144586140
Name:MONICA LEE, NP, PC
Entity Type:Organization
Organization Name:MONICA LEE, NP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:817-889-2609
Mailing Address - Street 1:3836 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2715
Mailing Address - Country:US
Mailing Address - Phone:817-889-2609
Mailing Address - Fax:817-889-2609
Practice Address - Street 1:8001 WESTERN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-3524
Practice Address - Country:US
Practice Address - Phone:817-889-2609
Practice Address - Fax:817-719-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682195314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility