Provider Demographics
NPI:1952124976
Name:LEE, WIVINA (RN)
Entity type:Individual
Prefix:
First Name:WIVINA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23360 BRIDLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5511
Mailing Address - Country:US
Mailing Address - Phone:928-951-2055
Mailing Address - Fax:
Practice Address - Street 1:23360 BRIDLE VIEW DR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-5511
Practice Address - Country:US
Practice Address - Phone:888-408-4364
Practice Address - Fax:575-339-0915
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC265403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse