Provider Demographics
NPI:1154707503
Name:LEE, RN B.S.N, JOEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:LEE, RN B.S.N
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S COLLEGE ST
Mailing Address - Street 2:APT. 228
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3372
Mailing Address - Country:US
Mailing Address - Phone:360-431-8332
Mailing Address - Fax:
Practice Address - Street 1:1210 S COLLEGE ST
Practice Address - Street 2:APT. 228
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3372
Practice Address - Country:US
Practice Address - Phone:360-431-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201500672RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical