Provider Demographics
NPI:1164230546
Name:LEE, DENISE K
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:K
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 1:33690 ROAD 760
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:NE
Mailing Address - Zip Code:69150-4105
Mailing Address - Country:US
Mailing Address - Phone:308-726-5727
Mailing Address - Fax:
Practice Address - Street 1:76215 ROAD 336
Practice Address - Street 2:
Practice Address - City:MADRID
Practice Address - State:NE
Practice Address - Zip Code:69150-4102
Practice Address - Country:US
Practice Address - Phone:308-326-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NE251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant