Provider Demographics
NPI:1639406424
Name:WILLERTON, DANA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LYNN
Last Name:WILLERTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 GAITHER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT. LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-810-9888
Mailing Address - Fax:856-810-9889
Practice Address - Street 1:101 GAITHER DRIVE
Practice Address - Street 2:
Practice Address - City:MT. LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-810-9888
Practice Address - Fax:856-810-9889
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00229800363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical