Provider Demographics
NPI:1275585168
Name:ECKERT, LYNN GORDON (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:GORDON
Last Name:ECKERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7528
Mailing Address - Country:US
Mailing Address - Phone:612-225-1538
Mailing Address - Fax:612-225-1591
Practice Address - Street 1:2340 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-7528
Practice Address - Country:US
Practice Address - Phone:612-225-1538
Practice Address - Fax:612-225-1591
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP53545Medicare UPIN