MEDICARE: MS. IRENE LEE LANCASTER LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN91323	CA

General Provider Information

NPI Number	:	1306987482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE LEE LANCASTER LVN

Provider Business Mailing Address
First Line	:	4655 BLANCHARD RD
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-8695
Country	:	US
Telephone Number	:	530-622-7891
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 SPRING ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4543
Country	:	US
Telephone Number	:	530-621-6206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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