Provider Demographics
NPI:1790440147
Name:PARTEE, AJA
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:PARTEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SUNRISE PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3222
Mailing Address - Country:US
Mailing Address - Phone:863-455-6342
Mailing Address - Fax:
Practice Address - Street 1:1429 LEWIS GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-9404
Practice Address - Country:US
Practice Address - Phone:863-455-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker