Provider Demographics
NPI:1467166744
Name:LEE, MARILYN DENICE WILLIAMS (FNP)
Entity Type:Individual
Prefix:
First Name:MARILYN DENICE
Middle Name:WILLIAMS
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 GUYMAR RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2916
Mailing Address - Country:US
Mailing Address - Phone:334-399-6517
Mailing Address - Fax:
Practice Address - Street 1:3138 GUYMAR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2916
Practice Address - Country:US
Practice Address - Phone:334-399-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily