Provider Demographics
NPI:1407549629
Name:LEE, TREINA D (LPN/LVN)
Entity Type:Individual
Prefix:
First Name:TREINA
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:LPN/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44618
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-0618
Mailing Address - Country:US
Mailing Address - Phone:216-785-0245
Mailing Address - Fax:216-938-8255
Practice Address - Street 1:9209 MEMPHIS VILLAS BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2430
Practice Address - Country:US
Practice Address - Phone:216-785-0245
Practice Address - Fax:216-938-8255
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.172344.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse