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General NPI Number Information
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NPI Number | 1437432036
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Entity Type | Individual
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Provider Name | LANCE LINCOLN PRIDE PA
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Gender | Male
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 601 JOHN ST STE M-460
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City | KALAMAZOO
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State | MI
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Zip | 49007-5355
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Country | US
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Telephone | 269-341-7333
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Fax | 269-341-7371
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Provider Business Mailing Address
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Address Line | 5301 E HURON RIVER DR
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City | YPSILANTI
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State | MI
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Zip | 48197-1051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5601006118
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601006118
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License Number State | MI
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