1104966837 NPI number — MRS. JANET TYCER LEE RN, MSN, ANP-C

Table of content: MRS. JANET TYCER LEE RN, MSN, ANP-C (NPI 1104966837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104966837 NPI number — MRS. JANET TYCER LEE RN, MSN, ANP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
JANET
Provider Middle Name:
TYCER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, ANP-C
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:
1104966837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1224 HIGHWAY 1046
Provider Second Line Business Mailing Address:
P.O. BOX 156
Provider Business Mailing Address City Name:
AMITE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70422-7002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-748-7727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15481 W CLUB DELUXE RD
Provider Second Line Business Practice Location Address:
S. TANGIPAHOA PARISH HEALTH UNIT
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-543-4170
Provider Business Practice Location Address Fax Number:
985-543-4171
Provider Enumeration Date:
02/08/2007

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: 363LA2200X , with the licence number:  RN045429 AP03479 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1109673 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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