Individual
MR. LANCE LINCOLN PRIDE
Active
Individual
MR. LANCE LINCOLN PRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601006118
MI
363AS0400X
Surgical Physician Assistant
5601006118
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10111084P
SENTARA HEALTH PLANS
VA
01
—
14374322036
TRICARE
VA
05
—
14374322036
—
VA
01
—
VV9406A
MEDICARE PTAN
VA
Enumeration date
09/21/2011
Last updated
11/27/2023
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