Provider Demographics
NPI:1679708515
Name:LANCASTER, DONNY GWEN
Entity type:Individual
Prefix:
First Name:DONNY
Middle Name:GWEN
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 KEYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1504
Mailing Address - Country:US
Mailing Address - Phone:903-759-2264
Mailing Address - Fax:903-759-2264
Practice Address - Street 1:3020 KEYSTONE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1504
Practice Address - Country:US
Practice Address - Phone:903-759-2264
Practice Address - Fax:903-759-2264
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164X00000X164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse