=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063880250
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARYANN LANCASTER CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2015
-----------------------------------------------------
Last Update Date | 09/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3145 HAMILTON MASON RD STE 200B 1ST FLR
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45011-8557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-844-1000
-----------------------------------------------------
Fax | 513-896-3727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4685 FOREST AVE STE C
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45212-3397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-853-4722
-----------------------------------------------------
Fax | 513-852-8525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | COA17896-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------