Provider Demographics
NPI:1508595513
Name:LESTER, WAYNE A
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:A
Last Name:LESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1717
Mailing Address - Country:US
Mailing Address - Phone:740-288-2091
Mailing Address - Fax:740-286-6732
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1717
Practice Address - Country:US
Practice Address - Phone:740-288-2091
Practice Address - Fax:740-286-6732
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH601249343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)