Provider Demographics
NPI:1609553049
Name:LEE, ROB BRENNAN (RN)
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:BRENNAN
Last Name:LEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:BRENNAN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:135 WESTFIELD CT APT 520
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5078
Mailing Address - Country:US
Mailing Address - Phone:971-244-2999
Mailing Address - Fax:
Practice Address - Street 1:100 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3927
Practice Address - Country:US
Practice Address - Phone:615-698-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN259068163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency