Provider Demographics
NPI:1265484372
Name:PLANK, LYNDA (MSN, APN-C)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:PLANK
Suffix:
Gender:F
Credentials:MSN, APN-C
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:GLENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APN-C
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:120 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1938
Practice Address - Country:US
Practice Address - Phone:856-546-3900
Practice Address - Fax:856-546-3908
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00001700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052374BDGMedicare PIN
NJP43722Medicare UPIN