Healthcare Provider Details

I. General information

NPI: 1164899845
Provider Name (Legal Business Name): MARY LANCASTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

IV. Provider business mailing address

105 JEFFERSON ST OFC
NATCHITOCHES LA
71457-4350
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-9299
  • Fax: 318-521-8031
Mailing address:
  • Phone: 318-357-2056
  • Fax: 318-521-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08326
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP08326
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: