Provider Demographics
NPI:1962413955
Name:LESTER, SUSAN JANE (RN, ANP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANE
Last Name:LESTER
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1433
Mailing Address - Country:US
Mailing Address - Phone:585-593-0485
Mailing Address - Fax:
Practice Address - Street 1:4192A BOLIVAR RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9325
Practice Address - Country:US
Practice Address - Phone:585-593-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301264363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01671672Medicaid
NYDD1624Medicare ID - Type Unspecified
NYS03335Medicare UPIN