Provider Demographics
NPI:1801893839
Name:LANCASTER, JENNIFER MANTER (CRNA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MANTER
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 SILVER FOX RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0683
Mailing Address - Country:US
Mailing Address - Phone:704-443-5237
Mailing Address - Fax:
Practice Address - Street 1:10628 PARK RD
Practice Address - Street 2:CAROLINAS MEDICAL CENTER-PINEVILLE
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8407
Practice Address - Country:US
Practice Address - Phone:704-667-1000
Practice Address - Fax:704-667-0409
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-254444163W00000X
OHNA07357367500000X
NC80491367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1023Medicaid
NC8052735Medicaid
SCAN1023Medicaid
NC2611455Medicare PIN