Provider Demographics
NPI:1497205884
Name:LEE, YOOMI
Entity Type:Individual
Prefix:
First Name:YOOMI
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CORLISS LANE
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3206
Mailing Address - Country:US
Mailing Address - Phone:603-237-8336
Mailing Address - Fax:603-237-4467
Practice Address - Street 1:141 CORLISS LN
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3206
Practice Address - Country:US
Practice Address - Phone:603-237-8336
Practice Address - Fax:603-237-4467
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72982163W00000X
NH064054-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse