Provider Demographics
NPI:1629847330
Name:LEE, ABBY JANE-MARIE
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:JANE-MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4402
Mailing Address - Country:US
Mailing Address - Phone:831-427-3387
Mailing Address - Fax:
Practice Address - Street 1:126 FRONT ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4402
Practice Address - Country:US
Practice Address - Phone:831-427-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker