Healthcare Provider Details

I. General information

NPI: 1962745208
Provider Name (Legal Business Name): KATIE ANNE LESTER LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST 3RD FLOOR
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

146 W RIVER ST 3RD FLOOR
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00747
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: