Provider Demographics
NPI:1508049461
Name:LEE, MARIA STELLA (PA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:STELLA
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:12647 OLIVE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6345
Mailing Address - Country:US
Mailing Address - Phone:314-744-4280
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:314-744-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant