Individual
GWENDOLYN LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5327 WILLOWS AVE, 1723 S 56 TH ST, PHILADELPHIA, PA 19143-4127
(215) 617-1175
Mailing address
5327 WILLOWS AVE, 1723 S 56 TH ST, PHILADELPHIA, PA 19143-4127
(215) 617-1175
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
27834708
PA
Other
Enumeration date
01/15/2026
Last updated
01/15/2026
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