Provider Demographics
NPI:1447782107
Name:LEE, ANNA (CNM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W COUNTRY CLUB RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5221
Mailing Address - Country:US
Mailing Address - Phone:575-624-4646
Mailing Address - Fax:575-625-8498
Practice Address - Street 1:350 W COUNTRY CLUB RD STE 203
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5221
Practice Address - Country:US
Practice Address - Phone:575-624-4646
Practice Address - Fax:575-625-8498
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY46744367A00000X
NM733367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife