Provider Demographics
NPI:1346750395
Name:YEALY, DANA A (CRNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:YEALY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PENN ST STE D
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1956
Mailing Address - Country:US
Mailing Address - Phone:717-632-0774
Mailing Address - Fax:717-633-5816
Practice Address - Street 1:848 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2029
Practice Address - Country:US
Practice Address - Phone:717-632-2700
Practice Address - Fax:717-632-1180
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP017951OtherCRNP PA STATE LICENSE