Provider Demographics
NPI:1760095921
Name:LESTER, JENNIFER ROSE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:LORADO
Mailing Address - State:WV
Mailing Address - Zip Code:25630-0143
Mailing Address - Country:US
Mailing Address - Phone:681-352-4027
Mailing Address - Fax:
Practice Address - Street 1:9918 BUFFALO CREEK ROAD
Practice Address - Street 2:
Practice Address - City:LORADO
Practice Address - State:WV
Practice Address - Zip Code:25630
Practice Address - Country:US
Practice Address - Phone:681-352-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant