Provider Demographics
NPI:1629811583
Name:LEE, STEPHANIE BENNETT (FNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BENNETT
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 N WILLIAMSBURG COUNTY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CADES
Mailing Address - State:SC
Mailing Address - Zip Code:29518-3008
Mailing Address - Country:US
Mailing Address - Phone:843-355-0180
Mailing Address - Fax:843-355-1606
Practice Address - Street 1:3555 N WILLIAMSBURG COUNTY HWY STE 100
Practice Address - Street 2:
Practice Address - City:CADES
Practice Address - State:SC
Practice Address - Zip Code:29518-3008
Practice Address - Country:US
Practice Address - Phone:843-355-0180
Practice Address - Fax:843-355-1606
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner