Provider Demographics
NPI:1750713269
Name:LESTER, MARY ANN (PAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:LESTER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2431
Mailing Address - Country:US
Mailing Address - Phone:304-425-3922
Mailing Address - Fax:304-487-0229
Practice Address - Street 1:365 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2431
Practice Address - Country:US
Practice Address - Phone:304-425-3922
Practice Address - Fax:304-487-0229
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV606OtherSTATE LICENSE