Healthcare Provider Details

I. General information

NPI: 1063827129
Provider Name (Legal Business Name): DIANE SUSAN LANCASTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-8420
  • Fax: 251-287-8478
Mailing address:
  • Phone: 251-287-8420
  • Fax: 251-287-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1-101513
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: