Provider Demographics
NPI:1114068061
Name:DYER, ELLEN M (CRNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:DYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:GRAYBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-782-6800
Mailing Address - Fax:717-782-6801
Practice Address - Street 1:2645 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2001
Practice Address - Country:US
Practice Address - Phone:717-782-6800
Practice Address - Fax:717-782-6801
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005993D363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102666740Medicaid
PA102666740Medicaid