Provider Demographics
NPI:1447812565
Name:LANCASTER, JERUSHA MICHAL (PA)
Entity type:Individual
Prefix:
First Name:JERUSHA
Middle Name:MICHAL
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5040 STAGECOACH WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2438
Mailing Address - Country:US
Mailing Address - Phone:817-733-9375
Mailing Address - Fax:
Practice Address - Street 1:5040 STAGECOACH WAY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2438
Practice Address - Country:US
Practice Address - Phone:817-733-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant