Provider Demographics
NPI:1861609604
Name:LEE, MILDRED ALJUNE (RN)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:ALJUNE
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4100
Mailing Address - Country:US
Mailing Address - Phone:540-636-2931
Mailing Address - Fax:540-636-2933
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-2931
Practice Address - Fax:540-636-2933
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001055816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001055816OtherRN LICENSE NUMBER