Provider Demographics
NPI:1003979410
Name:DREYER, EVELYN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARIE
Last Name:DREYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1241
Mailing Address - Country:US
Mailing Address - Phone:253-383-8342
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:300 JUBILEE DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4068
Practice Address - Country:US
Practice Address - Phone:877-341-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9651563Medicaid
WA8867625Medicare PIN
WAP00430008Medicare PIN
WA8867665Medicare PIN