Provider Demographics
NPI:1871117101
Name:ERNO, LEE DEVERE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:DEVERE
Last Name:ERNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 SUNTERRA TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9025
Mailing Address - Country:US
Mailing Address - Phone:231-459-6711
Mailing Address - Fax:
Practice Address - Street 1:1548 SUNTERRA TRL
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9025
Practice Address - Country:US
Practice Address - Phone:231-459-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle