Provider Demographics
NPI:1902696693
Name:LANCASTER, THEATRICE (CPT)
Entity type:Individual
Prefix:
First Name:THEATRICE
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 MALLVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2908
Mailing Address - Country:US
Mailing Address - Phone:630-607-4349
Mailing Address - Fax:888-453-5119
Practice Address - Street 1:464 MALLVIEW LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2908
Practice Address - Country:US
Practice Address - Phone:630-607-4349
Practice Address - Fax:888-453-5119
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24F-1942247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other