Provider Demographics
NPI:1609155829
Name:LANCER, BRIAN ALAN (FNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALAN
Last Name:LANCER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-2741
Mailing Address - Country:US
Mailing Address - Phone:336-330-0400
Mailing Address - Fax:336-330-0031
Practice Address - Street 1:3762 DURHAM RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-2741
Practice Address - Country:US
Practice Address - Phone:336-330-0400
Practice Address - Fax:336-330-0031
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC257390/5006904363LF0000X
NYF336824-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03539273Medicaid
NYJ400084083Medicare PIN