Provider Demographics
NPI:1316717010
Name:LANCASTER, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:LANCASTER-EL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CARLA LANCASTER-EL
Mailing Address - Street 1:11661 HAZELTON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1455
Mailing Address - Country:US
Mailing Address - Phone:586-765-3131
Mailing Address - Fax:
Practice Address - Street 1:15365 OAKFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1531
Practice Address - Country:US
Practice Address - Phone:586-765-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMIOOOO63832376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty