Provider Demographics
NPI:1598924326
Name:LEE, GERTRUDE L (RN)
Entity Type:Individual
Prefix:MS
First Name:GERTRUDE
Middle Name:L
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 1:23 PEACH TER
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1265
Mailing Address - Country:US
Mailing Address - Phone:845-561-6005
Mailing Address - Fax:
Practice Address - Street 1:23 PEACH TER
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1265
Practice Address - Country:US
Practice Address - Phone:845-561-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220785163W00000X, 163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAWAITING NPI #Medicaid
NYNEEDS NPI# TO ISSUEMedicaid