Provider Demographics
NPI:1386758787
Name:LEE, PHOEBE LANSING (RD)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:LANSING
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 3RD ST
Mailing Address - Street 2:APT 501
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7213
Mailing Address - Country:US
Mailing Address - Phone:208-386-9065
Mailing Address - Fax:
Practice Address - Street 1:200 N 3RD ST
Practice Address - Street 2:APT 501
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7213
Practice Address - Country:US
Practice Address - Phone:208-386-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD069133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered