Provider Demographics
NPI:1740081421
Name:LEE, TANYA RENAE (CBIS)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:RENAE
Last Name:LEE
Suffix:
Gender:
Credentials:CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368
Mailing Address - Country:US
Mailing Address - Phone:701-263-5748
Mailing Address - Fax:
Practice Address - Street 1:320 9TH ST SE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368
Practice Address - Country:US
Practice Address - Phone:701-263-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND160190171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach