Provider Demographics
NPI:1528474293
Name:LEE, LANA GEUMRAN (RN)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:GEUMRAN
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18804 64TH AVE
Mailing Address - Street 2:APT #6K
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3852
Mailing Address - Country:US
Mailing Address - Phone:347-572-5856
Mailing Address - Fax:
Practice Address - Street 1:7420 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1800
Practice Address - Country:US
Practice Address - Phone:718-736-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632627-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse