Provider Demographics
NPI:1508301862
Name:LANCASTER, BROOKE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 TEMPLE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4918 TEMPLE AVE STE G
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8502
Practice Address - Country:US
Practice Address - Phone:317-385-9454
Practice Address - Fax:812-461-6999
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11655133V00000X
IN37002988A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered