Healthcare Provider Details

I. General information

NPI: 1114753605
Provider Name (Legal Business Name): CINNAMON SHARI LANCASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 30TH AVE E
ALEXANDRIA MN
56308-4769
US

IV. Provider business mailing address

13029 COUNTY 38
EAGLE BEND MN
56446-4200
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6339
  • Fax: 320-759-2023
Mailing address:
  • Phone: 320-815-5650
  • Fax: 320-759-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168690
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: