Healthcare Provider Details

I. General information

NPI: 1639585383
Provider Name (Legal Business Name): DAWN L REPAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EXCELA HEALTH DR STE 203
LATROBE PA
15650-9001
US

IV. Provider business mailing address

100 EXCELA HEALTH DR STE 203
LATROBE PA
15650-9001
US

V. Phone/Fax

Practice location:
  • Phone: 724-539-6320
  • Fax: 724-539-6333
Mailing address:
  • Phone: 724-539-6320
  • Fax: 724-539-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013920
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: