Healthcare Provider Details

I. General information

NPI: 1619318656
Provider Name (Legal Business Name): SABRINA DIANE DVORAK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2013
Last Update Date: 07/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 LUTHERAN PKWY
WHEAT RIDGE CO
80033-6028
US

IV. Provider business mailing address

4335 DEPEW ST
WHEAT RIDGE CO
80212-7304
US

V. Phone/Fax

Practice location:
  • Phone: 303-301-7700
  • Fax:
Mailing address:
  • Phone: 303-330-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0172088
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: