Provider Demographics
NPI:1124864624
Name:LEE, DEMETRICE LASHONDA (VOCATIONAL NURSE)
Entity type:Individual
Prefix:MS
First Name:DEMETRICE
Middle Name:LASHONDA
Last Name:LEE
Suffix:
Gender:F
Credentials:VOCATIONAL NURSE
Other - Prefix:MS
Other - First Name:DEMETRICE
Other - Middle Name:LASHONDA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:VOCATIONAL NURSE
Mailing Address - Street 1:138 W 60TH ST # 918
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1114
Mailing Address - Country:US
Mailing Address - Phone:323-906-6119
Mailing Address - Fax:
Practice Address - Street 1:138 W 60TH ST # 918
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1114
Practice Address - Country:US
Practice Address - Phone:323-906-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239570164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse