Provider Demographics
NPI:1417194028
Name:LEE, DWANA (RN)
Entity Type:Individual
Prefix:
First Name:DWANA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SOUTH THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:MCGEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-0351
Mailing Address - Country:US
Mailing Address - Phone:870-222-3806
Mailing Address - Fax:870-222-3984
Practice Address - Street 1:901 SOUTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:MCGEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-0351
Practice Address - Country:US
Practice Address - Phone:870-222-3806
Practice Address - Fax:870-222-3984
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR78131163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health