Provider Demographics
NPI:1003460262
Name:LANCASTER, SUSAN A (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 TAYLOR AVE # A
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3030
Mailing Address - Country:US
Mailing Address - Phone:732-691-5881
Mailing Address - Fax:
Practice Address - Street 1:1541 ROUTE 88 STE A
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2373
Practice Address - Country:US
Practice Address - Phone:732-836-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00936900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care