Healthcare Provider Details

I. General information

NPI: 1790462711
Provider Name (Legal Business Name): HALEY NICHOLE LESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 FRIENDLY NEIGHBOR DR.
CHAPMANVILLE WV
25508
US

IV. Provider business mailing address

302 CANEBREAK RD
HANOVER WV
24839-8125
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-7104
  • Fax:
Mailing address:
  • Phone: 304-855-7104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number35503
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: