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General NPI Number Information
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NPI Number | 1801893839
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Entity Type | Individual
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Provider Name | JENNIFER MANTER LANCASTER CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 10628 PARK RD CAROLINAS MEDICAL CENTER-PINEVILLE
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City | CHARLOTTE
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State | NC
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Zip | 28210-8407
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Country | US
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Telephone | 704-667-1000
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Fax | 704-667-0409
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Provider Business Mailing Address
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Address Line | 6633 SILVER FOX RD
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City | CHARLOTTE
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State | NC
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Zip | 28270-0683
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Country | US
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Telephone | 704-443-5237
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-254444
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA07357
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 80491
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License Number State | NC
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