Provider Demographics
NPI:1790350775
Name:LEE, CHARLES STEVENS (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEVENS
Last Name:LEE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 GEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4020
Mailing Address - Country:US
Mailing Address - Phone:512-659-2046
Mailing Address - Fax:512-238-9559
Practice Address - Street 1:1111 N IH 35 STE 204
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4244
Practice Address - Country:US
Practice Address - Phone:512-238-6000
Practice Address - Fax:512-238-9559
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712700163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX712700OtherTEXAS BOARD OF NURSING