Provider Demographics
NPI:1891321980
Name:LEE, VONETTA A
Entity Type:Individual
Prefix:
First Name:VONETTA
Middle Name:A
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 1:1720 PINELAWN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3325
Mailing Address - Country:US
Mailing Address - Phone:419-775-6920
Mailing Address - Fax:
Practice Address - Street 1:4332 W CENTRAL AVE STE 220
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1669
Practice Address - Country:US
Practice Address - Phone:419-378-2331
Practice Address - Fax:513-672-2165
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440327Medicaid