Provider Demographics
NPI:1821481698
Name:LEE, KATIE JUYOUN
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JUYOUN
Last Name:LEE
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 1:15849 76TH RD
Mailing Address - Street 2:# 2B
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1012
Mailing Address - Country:US
Mailing Address - Phone:347-574-2250
Mailing Address - Fax:
Practice Address - Street 1:15849 76TH RD
Practice Address - Street 2:# 2B
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1012
Practice Address - Country:US
Practice Address - Phone:347-574-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580574163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse