Basic Information
Provider Information
NPI: 1003801192
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: HELEN
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 74751
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441940834
CountryCode: US
TelephoneNumber: 4409972262
FaxNumber:  
Practice Location
Address1: 2420 LAKE AVE
Address2:  
City: ASHTABULA
State: OH
PostalCode: 440044954
CountryCode: US
TelephoneNumber: 4409972262
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/14/2005
LastUpdateDate: 09/28/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XCOA.05265-NAOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
212269805OH MEDICAID


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