Provider Demographics
NPI:1841075090
Name:LEE, MICHELL (RN)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELL
Other - Middle Name:TERESA
Other - Last Name:BOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGES
Mailing Address - State:DE
Mailing Address - Zip Code:19733-0203
Mailing Address - Country:US
Mailing Address - Phone:302-605-0473
Mailing Address - Fax:302-832-2171
Practice Address - Street 1:40 HYBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT GEORGES
Practice Address - State:DE
Practice Address - Zip Code:19733-2015
Practice Address - Country:US
Practice Address - Phone:347-949-2171
Practice Address - Fax:302-832-2171
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0042464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse