Healthcare Provider Details

I. General information

NPI: 1548222755
Provider Name (Legal Business Name): REBECCA M LANCASTER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA M LANCASTER P.A.

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 2ND STREET
KENLY NC
27542
US

IV. Provider business mailing address

PO BOX 275
KENLY NC
27542-0275
US

V. Phone/Fax

Practice location:
  • Phone: 919-284-4025
  • Fax: 919-284-5965
Mailing address:
  • Phone: 919-284-4025
  • Fax: 919-284-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103808
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: