Provider Demographics
NPI:1750328910
Name:LANCASTER, WANDA LYNN (MSN, CNS, NP)
Entity Type:Individual
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First Name:WANDA
Middle Name:LYNN
Last Name:LANCASTER
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Gender:F
Credentials:MSN, CNS, NP
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Other - Middle Name:
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Mailing Address - Street 1:2317 EXECUTIVE CIR STE B
Mailing Address - Street 2:EXECUTIVE PARK WEST
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3762
Mailing Address - Country:US
Mailing Address - Phone:252-353-4968
Mailing Address - Fax:252-353-4967
Practice Address - Street 1:2317 EXECUTIVE CIR STE B
Practice Address - Street 2:EXECUTIVE PARK WEST
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3762
Practice Address - Country:US
Practice Address - Phone:252-353-4968
Practice Address - Fax:252-353-4967
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0060025-01364SP0809X
NC0050-01448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562149285OtherTIN 562149285
NC562149285OtherTIN 562149285