Healthcare Provider Details

I. General information

NPI: 1962723494
Provider Name (Legal Business Name): ERIN L LESTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/20/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LINDBLAD AVE.
GIRDWOOD AK
99587-1130
US

IV. Provider business mailing address

PO BOX 1130
GIRDWOOD AK
99587-1130
US

V. Phone/Fax

Practice location:
  • Phone: 907-783-1355
  • Fax:
Mailing address:
  • Phone: 77-831-3559
  • Fax: 907-743-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5668
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: