Healthcare Provider Details

I. General information

NPI: 1649939240
Provider Name (Legal Business Name): JULIA EILEEN DYREYES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MAIN ST STE 1AND2
ANNVILLE PA
17003-1643
US

IV. Provider business mailing address

718 MAPLE ST
ANNVILLE PA
17003-1524
US

V. Phone/Fax

Practice location:
  • Phone: 717-867-4671
  • Fax:
Mailing address:
  • Phone: 609-744-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSPO23917
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: