Provider Demographics
NPI:1679306039
Name:CONTRERAS, LEE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3651
Mailing Address - Country:US
Mailing Address - Phone:907-929-5826
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY AVE STE 2B
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3651
Practice Address - Country:US
Practice Address - Phone:907-929-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17123593747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant