Provider Demographics
NPI:1538471065
Name:LESTER, RYANE LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:RYANE
Middle Name:LEIGH
Last Name:LESTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RYANE
Other - Middle Name:LEIGH
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 W 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4480
Mailing Address - Country:US
Mailing Address - Phone:952-808-3000
Mailing Address - Fax:952-808-3001
Practice Address - Street 1:1000 W 140TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4480
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:952-808-3001
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1538471065Medicaid
MN1538471065Medicaid