Provider Demographics
NPI:1083256713
Name:DIETRICH, HAYLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 W LINCOLN HWY UNIT 405
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2658
Mailing Address - Country:US
Mailing Address - Phone:610-451-1634
Mailing Address - Fax:
Practice Address - Street 1:1650 CROOKED OAK DR STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4278
Practice Address - Country:US
Practice Address - Phone:717-569-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical