Individual
LINDA SUE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN JD MSN FNP-C
Contact information
Practice address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(574) 647-6510
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28070584A
IN
363LF0000X
Family Nurse Practitioner
Primary
71003570A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000712068
BCBS BEACON HEALTH SYSTEM
IN
05
—
201021500
—
IN
Enumeration date
10/07/2010
Last updated
10/14/2019
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