Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9501922 | CA |
NPI | 1003357781 |
---|---|
Provider Name | Kia Lee |
First Address | Marysville, CA 95901-6937 |
Second Address | Marysville, CA 95901-6937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 28/12/2021 |