Provider Demographics
NPI:1154855377
Name:STAINES, LESTEENA JOHANA
Entity Type:Individual
Prefix:MS
First Name:LESTEENA
Middle Name:JOHANA
Last Name:STAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESTEENA
Other - Middle Name:JOHANA
Other - Last Name:STAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:2045 LOWN FARM TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2045 LOWN FARM TRL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3952
Practice Address - Country:US
Practice Address - Phone:470-755-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157147363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health