Provider Demographics
NPI:1427668748
Name:DYREK, JULIE SUSANN (PMHNP-C APRN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:SUSANN
Last Name:DYREK
Suffix:
Gender:F
Credentials:PMHNP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 CONNIE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-6060
Mailing Address - Country:US
Mailing Address - Phone:337-274-9175
Mailing Address - Fax:
Practice Address - Street 1:1 LAKESHORE DR STE 1830
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0114
Practice Address - Country:US
Practice Address - Phone:337-437-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA214911OtherLOUISIANA STATE BOARD OF NURSING