Provider Demographics
NPI:1134945793
Name:LEE, MAI LAI (PN)
Entity type:Individual
Prefix:
First Name:MAI LAI
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-0053
Mailing Address - Country:US
Mailing Address - Phone:715-497-0366
Mailing Address - Fax:
Practice Address - Street 1:1909 BROADWAY ST S
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3271
Practice Address - Country:US
Practice Address - Phone:715-497-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI330747164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse