Provider Demographics
NPI:1023398724
Name:LECH, GWEN MARIE (GNP-BC)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:MARIE
Last Name:LECH
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2920
Mailing Address - Country:US
Mailing Address - Phone:215-386-1094
Mailing Address - Fax:
Practice Address - Street 1:4508 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19139-3608
Practice Address - Country:US
Practice Address - Phone:215-746-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO10396363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology