Provider Demographics
NPI:1417743345
Name:LEE, EUNICE
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 STILLWELL DR UNIT 4103
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6283
Mailing Address - Country:US
Mailing Address - Phone:336-964-6141
Mailing Address - Fax:
Practice Address - Street 1:1700 KILDAIRE FARM RD STE 210
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6572
Practice Address - Country:US
Practice Address - Phone:919-341-6010
Practice Address - Fax:984-333-9160
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5022661363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program