Provider Demographics
NPI:1295746733
Name:WRIGHT, GWEN (PAC)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4636
Mailing Address - Country:US
Mailing Address - Phone:610-328-1473
Mailing Address - Fax:
Practice Address - Street 1:194 W SPROUL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2027
Practice Address - Country:US
Practice Address - Phone:610-543-3246
Practice Address - Fax:610-543-1738
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002169L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical