Provider Demographics
NPI:1649576000
Name:MEYER, CARLY M (CRNP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:M
Last Name:MEYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:M
Other - Last Name:EARNEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:562 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1816
Mailing Address - Country:US
Mailing Address - Phone:717-626-2167
Mailing Address - Fax:717-626-1915
Practice Address - Street 1:562 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1816
Practice Address - Country:US
Practice Address - Phone:717-626-2167
Practice Address - Fax:717-626-1915
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner