1528081379 NPI number — MRS. CAROL A LEE FNP-C, PHD

Table of content: MRS. CAROL A LEE FNP-C, PHD (NPI 1528081379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528081379 NPI number — MRS. CAROL A LEE FNP-C, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
CAROL
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528081379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 EAST CLEVELAND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DILLON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-422-9926
Provider Business Mailing Address Fax Number:
910-422-9914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S BOND ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROWLAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28383-9639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-422-9926
Provider Business Practice Location Address Fax Number:
910-422-9914
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  200945 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7000427 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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