Provider Demographics
NPI:1669829818
Name:LEE, MINLI LILLIAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MINLI
Middle Name:LILLIAN
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MIN LI
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2625 W ALAMEDA AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4816
Mailing Address - Country:US
Mailing Address - Phone:818-843-5864
Mailing Address - Fax:818-843-5860
Practice Address - Street 1:2625 W ALAMEDA AVE STE 506
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-843-5864
Practice Address - Fax:818-843-5860
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95004218OtherNP LICENSE
CANPF95004218OtherNP FURNISHING NUMBER