Most Relevant Information
Provider Data
| NPI Number: | 1003409129 |
| Provider Name: | LISA NESTOR |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/19/2021 |
| Last Updated: | 02/19/2021 |
Provider Practice Location
3325 TRACE FORK RD
SOUTH CHARLESTON
WV
253095120
Practice Location Phone/Fax
| Phone: | 3047440259 |
| Fax: |
Provider Mailing Location
3325 TRACE FORK RD
SOUTH CHARLESTON
WV
253095120
Provider Mailing Phone/Fax
| Phone: | 3047440259 |
| Fax: |