Provider Demographics
NPI:1386213254
Name:LEE, KIRK J (RN)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3342
Mailing Address - Country:US
Mailing Address - Phone:810-278-7009
Mailing Address - Fax:
Practice Address - Street 1:8335 RIVER RD
Practice Address - Street 2:
Practice Address - City:COTTRELLVILLE
Practice Address - State:MI
Practice Address - Zip Code:48039-3342
Practice Address - Country:US
Practice Address - Phone:810-278-7009
Practice Address - Fax:810-765-3977
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704239545163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704239545OtherRN LICENSE