Provider Demographics
NPI:1669812020
Name:LEE, MORINDA
Entity type:Individual
Prefix:
First Name:MORINDA
Middle Name:
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 1:532 E 3RD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1621
Mailing Address - Country:US
Mailing Address - Phone:914-346-1725
Mailing Address - Fax:
Practice Address - Street 1:532 E 3RD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1621
Practice Address - Country:US
Practice Address - Phone:914-346-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse