Provider Demographics
NPI:1538700349
Name:LEE, JUDY LYN
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYN
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 1:21299 OLD 44 DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-7987
Mailing Address - Country:US
Mailing Address - Phone:530-222-1712
Mailing Address - Fax:
Practice Address - Street 1:21299 OLD 44 DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-7987
Practice Address - Country:US
Practice Address - Phone:530-222-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider