Provider Demographics
NPI:1538890264
Name:LESTER, LEWIS L IV (MPA)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:L
Last Name:LESTER
Suffix:IV
Gender:M
Credentials:MPA
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 589
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-0589
Mailing Address - Country:US
Mailing Address - Phone:218-410-5218
Mailing Address - Fax:
Practice Address - Street 1:120 GRANT AVE
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-1520
Practice Address - Country:US
Practice Address - Phone:218-410-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385H00000X, 251300000X, 322D00000X
251B00000X, 253Z00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children