Provider Demographics
NPI:1831407196
Name:DEJULIA, LAURA LOUISE (CRNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:DEJULIA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LOUISE
Other - Last Name:PASQUERILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2395 GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5209
Mailing Address - Country:US
Mailing Address - Phone:724-347-1861
Mailing Address - Fax:724-347-2532
Practice Address - Street 1:2395 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-347-1861
Practice Address - Fax:724-347-2532
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner