Provider Demographics
NPI:1700541976
Name:LEE, LYDIA ANNE
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANNE
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 1:701 PENN WALLER RD APT H1
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3143
Mailing Address - Country:US
Mailing Address - Phone:912-596-9350
Mailing Address - Fax:912-651-2366
Practice Address - Street 1:107B FAHM ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2391
Practice Address - Country:US
Practice Address - Phone:912-651-2253
Practice Address - Fax:912-651-2366
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN053545164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse