Doctor Name: | JONGMYEONG LEE |
NPI Number: | 1811921794 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | 02842 |
Business Practice Address: | 4371 E Lohman Ave Las Cruces, NM - 880118443 |
Business Phone Number: | 5755328900 |
Business Fax Number: | |
Mailing Address: | 4371 E Lohman Ave, LAS CRUCES |
State: | NM |
Postal Code: | 880118443 |
Phone Number: | 5755328900 |
Fax Number: | |
NPI Enumeration Date: | 07/10/2006 |
NPI Last Update Date: | 02/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 02842 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |