Provider Demographics
NPI:1073345336
Name:LESTER, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:LESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2125
Mailing Address - Country:US
Mailing Address - Phone:719-960-7165
Mailing Address - Fax:
Practice Address - Street 1:45 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2125
Practice Address - Country:US
Practice Address - Phone:719-960-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider