Provider Demographics
NPI:1952065997
Name:PENNINGTON-LEE, ADRIA E (RN)
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:E
Last Name:PENNINGTON-LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STATE HIGHWAY 310 STE 2
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1436
Mailing Address - Country:US
Mailing Address - Phone:315-386-2325
Mailing Address - Fax:
Practice Address - Street 1:80 STATE HIGHWAY 310
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1436
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor