Provider Demographics
NPI:1164899845
Name:LANCASTER, MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
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 1:105 JEFFERSON ST OFC
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4350
Mailing Address - Country:US
Mailing Address - Phone:318-357-2056
Mailing Address - Fax:318-521-8031
Practice Address - Street 1:1640 BREAZEALE SPRINGS ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4278
Practice Address - Country:US
Practice Address - Phone:318-352-9299
Practice Address - Fax:318-521-8031
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08326363L00000X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2433601Medicaid
LAAP08326OtherLICENSE