Provider Demographics
NPI:1154197051
Name:LESTER-POORE, LESLIE MARIAH
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIAH
Last Name:LESTER-POORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11482 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-9775
Mailing Address - Country:US
Mailing Address - Phone:734-829-8588
Mailing Address - Fax:
Practice Address - Street 1:3487 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3025
Practice Address - Country:US
Practice Address - Phone:866-498-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703123016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse