Provider Demographics
NPI:1295002244
Name:MCCOMSEY, GWENDOLYN L (PCD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:L
Last Name:MCCOMSEY
Suffix:
Gender:F
Credentials:PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N LIME ST
Mailing Address - Street 2:APT 2 FRONT
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3177
Mailing Address - Country:US
Mailing Address - Phone:717-371-7123
Mailing Address - Fax:
Practice Address - Street 1:30 N LIME ST
Practice Address - Street 2:APT 2 FRONT
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3177
Practice Address - Country:US
Practice Address - Phone:717-371-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGWENDOLYN52Medicaid