Provider Demographics
NPI:1548222755
Name:LANCASTER, REBECCA M (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-0275
Mailing Address - Country:US
Mailing Address - Phone:919-284-4025
Mailing Address - Fax:919-284-5965
Practice Address - Street 1:101 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542
Practice Address - Country:US
Practice Address - Phone:919-284-4025
Practice Address - Fax:919-284-5965
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103808363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8103148Medicaid