Provider Demographics
NPI:1528081379
Name:LEE, CAROL A (FNP-C, PHD)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 EAST CLEVELAND STREET
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536
Mailing Address - Country:US
Mailing Address - Phone:910-422-9926
Mailing Address - Fax:910-422-9914
Practice Address - Street 1:101 S BOND ST STE B
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-9639
Practice Address - Country:US
Practice Address - Phone:910-422-9926
Practice Address - Fax:910-422-9914
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000427Medicaid
NC7000427Medicaid
NC2599326BMedicare ID - Type UnspecifiedMEDICARE