Provider Demographics
NPI:1669275376
Name:LEE, NYADECH BOL II
Entity type:Individual
Prefix:MRS
First Name:NYADECH
Middle Name:BOL
Last Name:LEE
Suffix:II
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 1:2114 N 31ST ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-4273
Mailing Address - Country:US
Mailing Address - Phone:531-205-7310
Mailing Address - Fax:531-201-4505
Practice Address - Street 1:2114 N 31ST ST APT 2N
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-4273
Practice Address - Country:US
Practice Address - Phone:531-205-7310
Practice Address - Fax:531-201-4505
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health