Provider Demographics
NPI:1578523650
Name:REALL, BARBARA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:REALL
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 1:377 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1335
Mailing Address - Country:US
Mailing Address - Phone:215-534-1434
Mailing Address - Fax:
Practice Address - Street 1:377 RIDGE RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1335
Practice Address - Country:US
Practice Address - Phone:215-534-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007886363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health