Provider Demographics
NPI:1609368463
Name:LANCASTER, BROOKE HESTON (NP-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:HESTON
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 GET A WAY TRL
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730-3055
Mailing Address - Country:US
Mailing Address - Phone:605-660-9996
Mailing Address - Fax:
Practice Address - Street 1:110 N 29TH ST STE 301
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4466
Practice Address - Country:US
Practice Address - Phone:402-844-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112471363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care