Provider Demographics
NPI:1043295793
Name:LANCASTER, LUCILLE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARIE
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 S RAINBOWS END
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-4891
Mailing Address - Country:US
Mailing Address - Phone:480-982-4431
Mailing Address - Fax:480-671-0140
Practice Address - Street 1:2421 S RAINBOWS END
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-4891
Practice Address - Country:US
Practice Address - Phone:480-982-4431
Practice Address - Fax:480-671-0140
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN078971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868614Medicaid
AZZ89150Medicare ID - Type Unspecified
AZP49118Medicare UPIN