Provider Demographics
NPI:1184975302
Name:LEE, HEATHER ROXANNE (CRNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROXANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROXANNE
Other - Last Name:COLFLESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3130 VERA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3221
Mailing Address - Country:US
Mailing Address - Phone:808-295-4763
Mailing Address - Fax:
Practice Address - Street 1:3130 VERA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3221
Practice Address - Country:US
Practice Address - Phone:808-295-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA744422163W00000X
CA4292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse