Provider Demographics
NPI:1578920591
Name:LEE, PAUL (APRN-G)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:APRN-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 3RD ST
Mailing Address - Street 2:OPERATING ROOM
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1915
Mailing Address - Country:US
Mailing Address - Phone:618-534-2120
Mailing Address - Fax:618-222-4706
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:OPERATING ROOM
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1915
Practice Address - Country:US
Practice Address - Phone:618-534-2120
Practice Address - Fax:618-222-4706
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041352704163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant