Provider Demographics
NPI:1326646555
Name:LESTER, MELISSA SARAH
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SARAH
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 1:3807B TOWNSHIP ROAD 161
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-9463
Mailing Address - Country:US
Mailing Address - Phone:707-347-6165
Mailing Address - Fax:
Practice Address - Street 1:3807B TOWNSHIP ROAD 161
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-9463
Practice Address - Country:US
Practice Address - Phone:707-347-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7802560172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099982Medicaid