Provider Demographics
NPI:1619613981
Name:WEATHERS, LEE (MS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:WEATHERS-MIGUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:9747 DENALI CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6259
Mailing Address - Country:US
Mailing Address - Phone:916-980-0807
Mailing Address - Fax:
Practice Address - Street 1:9412 BIG HORN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1101
Practice Address - Country:US
Practice Address - Phone:916-226-2800
Practice Address - Fax:916-226-2804
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program