Provider Demographics
NPI:1467019349
Name:LEE, FORD W (NP)
Entity Type:Individual
Prefix:
First Name:FORD
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7900 W JEFFERSON BLVD STE 306
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-458-3610
Practice Address - Fax:260-479-4614
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2020-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71009051A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily