Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SPO10396 | PA |
NPI | 1023398724 |
---|---|
Provider Name | Ms. Gwen Marie Lech |
First Address | Phila, PA 19104-2920 |
Second Address | Phila, PA 19139-3608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 25/08/2011 |