Active NPI
Eternity Victoria Lee, LAT, ATC
- Athletic Trainer
- Brownsburg, IN
National Provider Identifier
1841787553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36003455A
- Practice address
- 1555 S Odell St
Brownsburg, IN 46112-8041 - Phone
- (317) 457-0906
- NPI assigned
- Apr 18, 2018
- Reactivated
- Nov 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36003455A | IN | Primary |
Addresses
Primary practice location
1555 S Odell St
Brownsburg, IN 46112-8041
Mailing address
615 Aspire CT Apt 105
Plainfield, IN 46168-5665
Other names 1
- Evie Victoria Lee
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36003455A | IN | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burris Laboratory School | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Muncie, IN
- NPI 1407984107
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636502400000",
"number": "1841787553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 ASPIRE CT APT 105",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461685665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 S ODELL ST",
"city": "BROWNSBURG",
"state": "IN",
"postal_code": "461128041",
"telephone_number": "317-457-0906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "ETERNITY",
"middle_name": "VICTORIA",
"name_prefix": "Ms.",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-18",
"last_updated": "2021-11-10",
"certification_date": "2021-11-10",
"deactivation_date": "2021-04-01",
"reactivation_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36003455A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EVIE",
"last_name": "LEE",
"middle_name": "VICTORIA",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Brownsburg, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.