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Individual

LEE MCDONALD DEFAZIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
62 INDUSTRIAL PARK RD, LAKE ARIEL, PA 18436-5606
(570) 689-7565
(570) 689-4803
Mailing address
1837 FAIR AVE, HONESDALE, PA 18431-2121
(570) 253-5838
(570) 253-6678

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP009466
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1025941780001
PA
05
1025941780002
PA
05
1025941780003
PA
05
1025941780004
PA
Enumeration date
10/19/2007
Last updated
03/17/2018
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