Healthcare Provider Details

I. General information

NPI: 1023339140
Provider Name (Legal Business Name): EMILY MARIE HADRAVA RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 2ND ST SUITE 2 COOK AREA HEALTH SERVICES, INC
TOWER MN
55790
US

IV. Provider business mailing address

20 5TH ST SE COOK AREA HEALTH SERVICES, INC
COOK MN
55723-9702
US

V. Phone/Fax

Practice location:
  • Phone: 218-666-5941
  • Fax:
Mailing address:
  • Phone: 218-666-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR172344-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: