Provider Demographics
NPI:1972012862
Name:LESNER, NOAH LEE
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:LEE
Last Name:LESNER
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 1:6365 WATERFORD HILL TER
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3380
Mailing Address - Country:US
Mailing Address - Phone:248-736-4458
Mailing Address - Fax:
Practice Address - Street 1:1200 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1032
Practice Address - Country:US
Practice Address - Phone:800-231-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2017-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3203058346146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic