Provider Demographics
NPI:1518959295
Name:LEES, BONNIE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:JEAN
Last Name:LEES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DODGE STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-6140
Mailing Address - Fax:402-955-3398
Practice Address - Street 1:8200 DODGE STREET
Practice Address - Street 2:CHILDREN'S HOSPITAL & MEDICARE CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-6140
Practice Address - Fax:402-955-3398
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR143592080N0001X
CA381632080N0001X
NV46802080N0001X
ND95682080N0001X
KS305742080N0001X
MN474312080N0001X
MO20050214622080N0001X
KS04305742080N0001X, 208000000X
NE256922080N0001X
ZZ311852080N0001X
CT233132080N0001X
MT120912080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131151Medicaid
KS200261300AMedicaid
CAXPY023900Medicaid
R111584Medicare ID - Type Unspecified
KS200261300AMedicaid
CAXPY023900Medicaid