Individual
MS. MARY REGINA LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
310 SE BROWN ST, LAKE CITY, FL 32025-5956
(386) 961-9243
Mailing address
310 SE BROWN ST, LAKE CITY, FL 32025-5956
(386) 961-9243
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
164W00000X
FL
Other
Enumeration date
10/09/2012
Last updated
10/09/2012
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