Provider Demographics
NPI:1295849321
Name:LEE, DANA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 188TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6160
Mailing Address - Country:US
Mailing Address - Phone:808-769-1447
Mailing Address - Fax:
Practice Address - Street 1:3021 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022
Practice Address - Country:US
Practice Address - Phone:360-825-6511
Practice Address - Fax:360-802-5036
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI11421208000000X
WAMD60544466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50529001Medicaid
HIG65119Medicare UPIN