Provider Demographics
NPI:1407176050
Name:LANCING, DARRYL WAYNE (CCP)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:WAYNE
Last Name:LANCING
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 S BIRCHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1203
Mailing Address - Country:US
Mailing Address - Phone:972-757-3272
Mailing Address - Fax:
Practice Address - Street 1:3100 W END AVE STE 800
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1378
Practice Address - Country:US
Practice Address - Phone:877-345-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist