Provider Demographics
NPI:1437135837
Name:LEE, DEBORAH (APRN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN
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 3162
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-3162
Mailing Address - Country:US
Mailing Address - Phone:207-942-6996
Mailing Address - Fax:207-942-3632
Practice Address - Street 1:17 DOUGHTY DRIVE
Practice Address - Street 2:STE 212
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-942-6996
Practice Address - Fax:207-942-3632
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO 20030163WP0808X
MEAS 084093364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENS8081Medicare PIN