Provider Demographics
NPI:1790462711
Name:LESTER, HALEY NICHOLE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:NICHOLE
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 1:302 CANEBREAK RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:WV
Mailing Address - Zip Code:24839-8125
Mailing Address - Country:US
Mailing Address - Phone:304-855-7104
Mailing Address - Fax:
Practice Address - Street 1:46 FRIENDLY NEIGHBOR DR.
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35503164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse