Healthcare Provider Details

I. General information

NPI: 1104932029
Provider Name (Legal Business Name): WANDA A. LANCASTER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COLE DR
PIGEON FORGE TN
37863-3775
US

IV. Provider business mailing address

711 SIGNAL MOUNTAIN RD # 304
CHATTANOOGA TN
37405-1823
US

V. Phone/Fax

Practice location:
  • Phone: 865-428-5454
  • Fax: 865-429-5616
Mailing address:
  • Phone: 865-360-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN7565
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: