Provider Demographics
NPI:1649829060
Name:LEE, ANTWYLA CHADELL
Entity type:Individual
Prefix:MRS
First Name:ANTWYLA
Middle Name:CHADELL
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 HWY 1045
Mailing Address - Street 2:AMITE
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422
Mailing Address - Country:US
Mailing Address - Phone:985-507-0368
Mailing Address - Fax:215-358-2736
Practice Address - Street 1:3285 HWY 1045
Practice Address - Street 2:AMITE
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422
Practice Address - Country:US
Practice Address - Phone:985-507-0368
Practice Address - Fax:215-358-2736
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)