Healthcare Provider Details

I. General information

NPI: 1891882163
Provider Name (Legal Business Name): DEBRA J LANCASTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N FORD AVE
BUCKLIN KS
67834-3460
US

IV. Provider business mailing address

222 MAIN ST PO BOX 127
BLOOM KS
67865-8511
US

V. Phone/Fax

Practice location:
  • Phone: 620-826-3266
  • Fax: 620-826-3527
Mailing address:
  • Phone: 620-885-4202
  • Fax: 620-885-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44276
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: