Provider Demographics
NPI:1386613172
Name:LONSCAK, GREGORY P (DC, DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:LONSCAK
Suffix:
Gender:M
Credentials:DC, DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7840
Mailing Address - Country:US
Mailing Address - Phone:843-247-3655
Mailing Address - Fax:
Practice Address - Street 1:1718 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1927
Practice Address - Country:US
Practice Address - Phone:843-986-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2493111N00000X
SC18114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2493Medicaid
U858388188Medicare PIN