Healthcare Provider Details

I. General information

NPI: 1578889481
Provider Name (Legal Business Name): STEPHEN C LESTER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC SFT UNIT 25850, BOX 7
APO AE
09033
US

IV. Provider business mailing address

CMR 427 BOX 729
APO AE
09033
US

V. Phone/Fax

Practice location:
  • Phone: 314-354-6771
  • Fax:
Mailing address:
  • Phone: 314-354-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number301287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: