Healthcare Provider Details

I. General information

NPI: 1740354554
Provider Name (Legal Business Name): MARY ANN LANCASTER APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH BRIDGE STREET RICHARD HALL COMMUNITY MENTAL HEALTH CENTER
BRIDGEWATER NJ
08807
US

IV. Provider business mailing address

723 KEARNY AVENUE
KEARNY NJ
07032-3005
US

V. Phone/Fax

Practice location:
  • Phone: 908-253-3166
  • Fax: 908-704-1790
Mailing address:
  • Phone: 201-997-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NO04712900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: