Provider Demographics
NPI:1740961671
Name:LEE, LILA DIAN (RN)
Entity type:Individual
Prefix:MS
First Name:LILA
Middle Name:DIAN
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LILA
Other - Middle Name:LEE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1277 GRANTS WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-5500
Mailing Address - Country:US
Mailing Address - Phone:205-732-2521
Mailing Address - Fax:
Practice Address - Street 1:1600 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1701
Practice Address - Country:US
Practice Address - Phone:205-638-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-051191163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics