Provider Demographics
NPI:1548550387
Name:LEE, OLIVE MAUREEN (CNA/PCA)
Entity type:Individual
Prefix:MISS
First Name:OLIVE
Middle Name:MAUREEN
Last Name:LEE
Suffix:
Gender:F
Credentials:CNA/PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 NW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5511
Mailing Address - Country:US
Mailing Address - Phone:954-538-4831
Mailing Address - Fax:
Practice Address - Street 1:4421 NW 37TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-5511
Practice Address - Country:US
Practice Address - Phone:954-538-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 34317376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686049496OtherMED WAIVER