Provider Demographics
NPI:1558654814
Name:LEE, BEVERLEY (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 WASHINGTON AVE
Mailing Address - Street 2:SUITE 1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:881 WASHINGTON AVE
Practice Address - Street 2:SUITE 1L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1040
Practice Address - Country:US
Practice Address - Phone:347-663-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611221-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse