Provider Demographics
NPI:1710635198
Name:LEE, KAITLEN KAROLINA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KAITLEN
Middle Name:KAROLINA
Last Name:LEE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:KAITLEN
Other - Middle Name:KAROLINA
Other - Last Name:UECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2125
Mailing Address - Country:US
Mailing Address - Phone:701-840-4630
Mailing Address - Fax:
Practice Address - Street 1:3362 119TH AVE SE
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-9405
Practice Address - Country:US
Practice Address - Phone:701-840-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR47841163WH0200X, 3747P1801X
251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care