Provider Demographics
NPI:1306382056
Name:LANKFORD, MARY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:LANKFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:5101 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-2219
Mailing Address - Country:US
Mailing Address - Phone:858-351-6057
Mailing Address - Fax:
Practice Address - Street 1:5101 MARKET ST STE 2000
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-2225
Practice Address - Country:US
Practice Address - Phone:858-351-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551811163WC1500X
CA683944163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health