Basic Information
| Provider Information | |||||||||
| NPI: | 1275585168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKERT | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | GORDON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 SPRING FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276157528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122251538 | ||||||||
| FaxNumber: | 6122251591 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 SPRING FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276157528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122251538 | ||||||||
| FaxNumber: | 6122251591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 101608 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.