Provider Demographics
NPI:1730117334
Name:DEE, VIVIAN (APRN-C)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:DEE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MICHELANGELO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4758
Mailing Address - Country:US
Mailing Address - Phone:210-364-3263
Mailing Address - Fax:210-485-6825
Practice Address - Street 1:7400 MERTON MINTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78299
Practice Address - Country:US
Practice Address - Phone:210-818-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX768535363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health