Provider Demographics
NPI:1053902833
Name:LEE, DENISE LYNN
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9329 INFIRMARY RD LOT B121
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9005
Mailing Address - Country:US
Mailing Address - Phone:330-931-1012
Mailing Address - Fax:
Practice Address - Street 1:9329 INFIRMARY RD LOT B121
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-9005
Practice Address - Country:US
Practice Address - Phone:330-931-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRT927544OtherDRIVER LICENSE