MEDICARE: WANDA LYNN LANCASTER MSN, CNS, NP

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	0060025-01	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0050-01448	NC

General Provider Information

NPI Number	:	1750328910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA LYNN LANCASTER MSN, CNS, NP

Provider Business Mailing Address
First Line	:	2317 EXECUTIVE CIR STE B
Second Line	:	EXECUTIVE PARK WEST
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3762
Country	:	US
Telephone Number	:	252-353-4968
Fax Number	:	252-353-4967

Provider Business Practice Location Address
First Line	:	2317 EXECUTIVE CIR STE B
Second Line	:	EXECUTIVE PARK WEST
City	:	GREENVILLE
State	:	NC
Zip	:	27834-3762
Country	:	US
Telephone Number	:	252-353-4968
Fax Number	:	252-353-4967

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/24/2024

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