Provider Demographics
NPI:1811957111
Name:RAUDENBUSH, LEE GRAHAM (PA)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:GRAHAM
Last Name:RAUDENBUSH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5804 HIBERNIA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1302
Mailing Address - Country:US
Mailing Address - Phone:910-488-8055
Mailing Address - Fax:
Practice Address - Street 1:3425 MELROSE RD
Practice Address - Street 2:BEHAVIORAL HEALTH CARE
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1608
Practice Address - Country:US
Practice Address - Phone:910-615-3738
Practice Address - Fax:910-609-3784
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001-01241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant