Provider Demographics
NPI:1629388517
Name:MOREHEAD-LEE, CYNTHIA RENEE' (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEE'
Last Name:MOREHEAD-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 1:721 S NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-5801
Mailing Address - Country:US
Mailing Address - Phone:888-492-0677
Mailing Address - Fax:866-493-9431
Practice Address - Street 1:721 S NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-5801
Practice Address - Country:US
Practice Address - Phone:888-492-0677
Practice Address - Fax:866-493-9431
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO196840163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice