1477846285 NPI number — DR. MARQUISHA RENEE GREEN LEE PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477846285 NPI number — DR. MARQUISHA RENEE GREEN LEE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
MARQUISHA
Provider Middle Name:
RENEE GREEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
MARQUISHA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477846285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MADIGAN ARMY MEDICAL CTR
Provider Second Line Business Mailing Address:
9040A JACKSON AVENUE
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-2827
Provider Business Mailing Address Fax Number:
253-968-0920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CTR
Provider Second Line Business Practice Location Address:
9040A JACKSON AVENUE
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-2827
Provider Business Practice Location Address Fax Number:
253-968-0920
Provider Enumeration Date:
05/26/2011

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: 103T00000X , with the licence number:  4022 , 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)





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