Provider Demographics
NPI:1497349385
Name:LEE, NICOLAS JERMAINE
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:JERMAINE
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W FLAMINGO RD STE 1441
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3924
Mailing Address - Country:US
Mailing Address - Phone:702-758-3957
Mailing Address - Fax:
Practice Address - Street 1:4100 W FLAMINGO RD STE 1441
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3924
Practice Address - Country:US
Practice Address - Phone:702-758-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health