Provider Demographics
NPI:1407087687
Name:DEJOHN, DENISE L (CRNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:DEJOHN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:L
Other - Last Name:BREWER
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:
Mailing Address - Fax:
Practice Address - Street 1:4310 LONDONDERRY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5300
Practice Address - Country:US
Practice Address - Phone:717-988-0611
Practice Address - Fax:717-231-8778
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102961268Medicaid
PA189226Medicare PIN