Provider Demographics
NPI:1497388508
Name:LUPTON, GWENDOLYN ANN
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ANN
Last Name:LUPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 CANTILLON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2023
Mailing Address - Country:US
Mailing Address - Phone:609-601-8611
Mailing Address - Fax:
Practice Address - Street 1:1409 CANTILLON BLVD
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2023
Practice Address - Country:US
Practice Address - Phone:609-601-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00944800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner