Provider Demographics
NPI:1164672796
Name:LEE, MELODY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 KILROY AIRPORT WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-6818
Mailing Address - Country:US
Mailing Address - Phone:855-828-7226
Mailing Address - Fax:562-285-9494
Practice Address - Street 1:3800 KILROY AIRPORT WAY STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-6818
Practice Address - Country:US
Practice Address - Phone:558-287-2268
Practice Address - Fax:562-285-9494
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily