Provider Demographics
NPI:1528599164
Name:LEE, MOHOGANY TYIESE
Entity Type:Individual
Prefix:
First Name:MOHOGANY
Middle Name:TYIESE
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 1:13854 LAKESIDE CIR
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1316
Mailing Address - Country:US
Mailing Address - Phone:586-580-4977
Mailing Address - Fax:
Practice Address - Street 1:13854 LAKESIDE CIR
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1316
Practice Address - Country:US
Practice Address - Phone:586-435-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider