Provider Demographics
NPI:1174275432
Name:LEE, LETEACE (IBCLC, RN)
Entity Type:Individual
Prefix:
First Name:LETEACE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10426 SUGARBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5732
Mailing Address - Country:US
Mailing Address - Phone:804-255-4893
Mailing Address - Fax:
Practice Address - Street 1:10426 SUGARBERRY ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5732
Practice Address - Country:US
Practice Address - Phone:804-255-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230850163WL0100X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn