Provider Demographics
NPI:1578210936
Name:LEE, SAMANTHA-ROSE DE LEON (APRN, FNP-BC, CANS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA-ROSE
Middle Name:DE LEON
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN, FNP-BC, CANS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 W CRAIG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2743
Mailing Address - Country:US
Mailing Address - Phone:725-300-7705
Mailing Address - Fax:
Practice Address - Street 1:4640 W CRAIG RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2743
Practice Address - Country:US
Practice Address - Phone:702-982-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV852106363LF0000X
NVTEMP852106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily