Healthcare Provider Details

I. General information

NPI: 1235319427
Provider Name (Legal Business Name): JOEY VORK RN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 07/21/2022
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 TRETTEL LN
CLOQUET MN
55720-1345
US

IV. Provider business mailing address

657 E MAIN ST
ANOKA MN
55303-2528
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-1227
  • Fax:
Mailing address:
  • Phone: 218-786-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 140757-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: