Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | F335867 | NY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 335867 | NY |
NPI | 1386078970 |
---|---|
Provider Name | Raciel Lee |
First Address | Poughkeepsie, NY 12601-3947 |
Second Address | Poughkeepsie, NY 12601-3947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 24/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03733722 | (05) | NY |