Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO459 | DC |
NPI | 1245392968 |
---|---|
Provider Name | Mrs. Audrey Eloise Lee |
First Address | Mitchellville, MD 20721-1210 |
Second Address | Washington, DC 20009-6865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2006 |
Last Update Date | 08/07/2007 |