Provider Demographics
NPI:1841038890
Name:LEE, EULSON MOONIE (FNP)
Entity type:Individual
Prefix:
First Name:EULSON
Middle Name:MOONIE
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 E SILVER DOLLAR LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1355
Mailing Address - Country:US
Mailing Address - Phone:949-285-7363
Mailing Address - Fax:
Practice Address - Street 1:16100 SAND CANYON AVE STE 240
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3724
Practice Address - Country:US
Practice Address - Phone:949-393-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily