MEDICARE: GWENDOLYN LANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	27834708	PA

General Provider Information

NPI Number	:	1659239879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN LANE

Provider Business Mailing Address
First Line	:	5327 WILLOWS AVE
Second Line	:	1723 S 56 TH ST
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4127
Country	:	US
Telephone Number	:	215-617-1175
Fax Number	:

Provider Business Practice Location Address
First Line	:	5327 WILLOWS AVE
Second Line	:	1723 S 56 TH ST
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4127
Country	:	US
Telephone Number	:	215-617-1175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ GWENDOLYN LANE ” Practice Location

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