Provider Demographics
NPI:1164852166
Name:GUENTHER, LEE M (APRN)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:M
Last Name:GUENTHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:MARIE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-6615
Mailing Address - Fax:502-253-6618
Practice Address - Street 1:2400 EASTPOINT PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4154
Practice Address - Country:US
Practice Address - Phone:502-253-6615
Practice Address - Fax:502-253-6618
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100334840Medicaid
KYK128210Medicare PIN