Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP08326 | LA |
N | 363LC1500X | Nurse Practitioner - Community Health | AP08326 | LA |
NPI | 1164899845 |
---|---|
Provider Name | Ms. Mary Lancaster |
First Address | Natchitoches, LA 71457-4350 |
Second Address | Natchitoches, LA 71457-4278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2015 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2433601 | (05) | LA |
AP08326 | LICENSE (01) | LA |