Provider Demographics
NPI:1255746889
Name:LEE, DIANE (LVN)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 ADAM GRUBB
Mailing Address - Street 2:STE:400
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3511
Mailing Address - Country:US
Mailing Address - Phone:817-238-4441
Mailing Address - Fax:817-238-4454
Practice Address - Street 1:3800 ADAM GRUBB
Practice Address - Street 2:STE:400
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3511
Practice Address - Country:US
Practice Address - Phone:817-238-4441
Practice Address - Fax:817-238-4454
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX111042164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse