Provider Demographics
NPI:1669685558
Name:LEE, NANCY SHAWN (NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SHAWN
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3715
Mailing Address - Street 2:425 15TH ST.
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-1715
Mailing Address - Country:US
Mailing Address - Phone:310-374-9845
Mailing Address - Fax:
Practice Address - Street 1:911 E SAN ANTONIO DR
Practice Address - Street 2:#4
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2204
Practice Address - Country:US
Practice Address - Phone:310-704-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN376827363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health