Provider Demographics
NPI:1053946319
Name:WESLEY-LYNCH, GREGORY WILLIAM (CRNP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:WILLIAM
Last Name:WESLEY-LYNCH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:215-203-4072
Mailing Address - Fax:
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:215-203-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily