Most Relevant Information
Provider Data
| NPI Number: | 1003303017 |
| Provider Name: | NICOLE LEE |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 2893 |
Most Important Dates
| Enumeration Date: | 04/16/2018 |
| Last Updated: | 10/31/2018 |
Provider Practice Location
4913 W RENO AVE
OKLAHOMA CITY
OK
731276339
Practice Location Phone/Fax
| Phone: | 4059484900 |
| Fax: |
Provider Mailing Location
4913 W RENO AVE
OKLAHOMA CITY
OK
731276339
Provider Mailing Phone/Fax
| Phone: | 4059484900 |
| Fax: |