Provider Demographics
NPI:1992524284
Name:LEE, ERICA (RN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
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 1:2022 BATTERY PARK DR.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:KY
Mailing Address - Zip Code:42740
Mailing Address - Country:US
Mailing Address - Phone:901-499-9569
Mailing Address - Fax:
Practice Address - Street 1:2022 BATTERY PARK DR.
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:KY
Practice Address - Zip Code:42740
Practice Address - Country:US
Practice Address - Phone:901-499-9569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1108360163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health