Provider Demographics
NPI:1669216990
Name:LEE, BRENDA SUE (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 S SEPULVEDA BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5239
Mailing Address - Country:US
Mailing Address - Phone:310-880-1060
Mailing Address - Fax:
Practice Address - Street 1:3310 S SEPULVEDA BLVD APT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5239
Practice Address - Country:US
Practice Address - Phone:310-880-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362531163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant