NPI 1104174085

Johnnie Legrant Lee

Practitioner Adult Care Home Facility Minneapolis, MN

Practice location

Address: 4347 4th Ave S, Minneapolis, MN 55409-2115
Phone: (612) 823-3880

Registered specialties

Adult Care Home Facility Primary

Nursing & Custodial Care Facilities Taxonomy 311ZA0620X Licence 270227392 (MN)

Other Custodial Care Facility providers in Minnesota →

Registry record

NPI: 1104174085
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Aug 2012
Record last updated: 26 Aug 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.