Provider Demographics
NPI:1629020581
Name:LEE, DONNA GAYLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:GAYLE
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 E HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1694
Mailing Address - Country:US
Mailing Address - Phone:704-864-8749
Mailing Address - Fax:
Practice Address - Street 1:1075 E HUDSON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1694
Practice Address - Country:US
Practice Address - Phone:704-864-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629020581OtherNPI
NCS59051OtherUPIN
NC2597081AMedicare UPIN