Provider Demographics
NPI:1790439917
Name:LEE, REBECCA JO
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:FRANTSVOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2720 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1600
Mailing Address - Country:US
Mailing Address - Phone:701-833-0627
Mailing Address - Fax:
Practice Address - Street 1:2720 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1600
Practice Address - Country:US
Practice Address - Phone:701-833-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant