Basic Information
| Provider Information | |||||||||
| NPI: | 1336481357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASTOGI-WILSON | ||||||||
| FirstName: | GUNJAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 W CHELTENHAM AVE | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190271046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158845715 | ||||||||
| FaxNumber: | 2158841442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1939 W CHELTENHAM AVE | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190271046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158845715 | ||||||||
| FaxNumber: | 2158841442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2013 | ||||||||
| LastUpdateDate: | 03/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP012453 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.