Individual
MADELINE GRACE LANCASTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 N WEST ST, JACKSON, MS 39202-1033
(769) 777-1201
Mailing address
1900 N WEST ST, JACKSON, MS 39202-1033
(769) 777-1201
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
RBT-22-216725
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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