Provider Demographics
NPI:1336609726
Name:LEE, SONYONG A (MSN, APRN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SONYONG
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN, APRN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19284 STONE OAK PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3474
Mailing Address - Country:US
Mailing Address - Phone:210-268-0124
Mailing Address - Fax:210-268-0146
Practice Address - Street 1:19284 STONE OAK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3474
Practice Address - Country:US
Practice Address - Phone:210-246-0124
Practice Address - Fax:210-246-0146
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141072363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXML5314593OtherDEA