Provider Demographics
NPI:1144954512
Name:LESTER, SHANIA
Entity type:Individual
Prefix:
First Name:SHANIA
Middle Name:
Last Name:LESTER
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:CLEAR FORK
Mailing Address - State:WV
Mailing Address - Zip Code:24822-0177
Mailing Address - Country:US
Mailing Address - Phone:304-860-3250
Mailing Address - Fax:
Practice Address - Street 1:573 ELK LICK RD
Practice Address - Street 2:
Practice Address - City:CLEAR FORK
Practice Address - State:WV
Practice Address - Zip Code:24822-1126
Practice Address - Country:US
Practice Address - Phone:304-860-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant