MEDICARE: MS. MARY LANCASTER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP08326	LA
2	363LC1500X	Community Health Nurse Practitioner	AP08326	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AP08326	OTHER	LA	LICENSE

General Provider Information

NPI Number	:	1164899845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY LANCASTER NP

Provider Business Mailing Address
First Line	:	105 JEFFERSON ST OFC
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-4350
Country	:	US
Telephone Number	:	318-357-2056
Fax Number	:	318-521-8031

Provider Business Practice Location Address
First Line	:	1640 BREAZEALE SPRINGS ST
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-4278
Country	:	US
Telephone Number	:	318-352-9299
Fax Number	:	318-521-8031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	10/19/2020

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