MEDICARE: CARLA LANCASTER

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	376K00000X	Nurse's Aide	MIOOOO63832	MI

General Provider Information

NPI Number	:	1316717010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA LANCASTER

Provider Business Mailing Address
First Line	:	11661 HAZELTON
Second Line	:
City	:	REDFORD
State	:	MI
Zip	:	48239-1455
Country	:	US
Telephone Number	:	586-765-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	15365 OAKFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1531
Country	:	US
Telephone Number	:	586-765-3131
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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Directions to “ CARLA LANCASTER ” Practice Location

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