Healthcare Provider Details

I. General information

NPI: 1093055295
Provider Name (Legal Business Name): BONNIE WHITE LANCASTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CEDAR SPRINGS RD
SPARTANBURG SC
29302-4628
US

IV. Provider business mailing address

335 CEDAR SPRINGS ROAD
SPARTANBURG SC
29302
US

V. Phone/Fax

Practice location:
  • Phone: 864-577-7675
  • Fax: 864-577-7629
Mailing address:
  • Phone: 864-577-7675
  • Fax: 864-577-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number71849
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: