Provider Demographics
NPI:1215376017
Name:DIPERSTEIN, JULIE R (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:DIPERSTEIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 FOREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3653
Mailing Address - Country:US
Mailing Address - Phone:570-212-1741
Mailing Address - Fax:
Practice Address - Street 1:610 W GERMANTOWN PIKE STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1062
Practice Address - Country:US
Practice Address - Phone:610-525-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN57739163W00000X
NJ26NR14205100367500000X
PARN577359367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse