Provider Demographics
NPI:1588993141
Name:LEE, RAVEN (LPN)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 VISTA VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6922
Mailing Address - Country:US
Mailing Address - Phone:614-352-8692
Mailing Address - Fax:
Practice Address - Street 1:3062 VISTA VIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6922
Practice Address - Country:US
Practice Address - Phone:614-352-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136511164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse