Healthcare Provider Details

I. General information

NPI: 1396874145
Provider Name (Legal Business Name): JULIE A DVORAK CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 N SOCORA ST SUITE 4
WICHITA KS
67212-3279
US

IV. Provider business mailing address

834 N SOCORA ST SUITE 4
WICHITA KS
67212-3279
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-2802
  • Fax: 316-440-2809
Mailing address:
  • Phone: 316-440-2802
  • Fax: 316-440-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1376200012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: