Provider Demographics
NPI:1831106731
Name:LEE, NANCY E (PA C)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELLEN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:874 AMERICAN PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8800
Mailing Address - Country:US
Mailing Address - Phone:702-777-4749
Mailing Address - Fax:702-777-1768
Practice Address - Street 1:874 AMERICAN PACIFIC DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8800
Practice Address - Country:US
Practice Address - Phone:702-777-4749
Practice Address - Fax:702-777-1768
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303973100Medicaid