Provider Demographics
NPI:1013440619
Name:LEE, AUDREY H
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:H
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 1:28264 SOUTHAMPTON PKWY
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23837-2125
Mailing Address - Country:US
Mailing Address - Phone:757-742-6081
Mailing Address - Fax:757-742-6111
Practice Address - Street 1:28264 SOUTHAMPTON PKWY
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:VA
Practice Address - Zip Code:23837-2125
Practice Address - Country:US
Practice Address - Phone:757-742-6081
Practice Address - Fax:757-742-6111
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT61509489343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)