Provider Demographics
NPI:1649842469
Name:LEE, WINNIE (ODS-C)
Entity type:Individual
Prefix:
First Name:WINNIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:ODS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2097 E WASHINGTON ST # 1E201
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4738
Mailing Address - Country:US
Mailing Address - Phone:909-905-4711
Mailing Address - Fax:
Practice Address - Street 1:510 BUTLER AVE (613/111)
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-9990
Practice Address - Country:US
Practice Address - Phone:909-905-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20171941744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder