Healthcare Provider Details

I. General information

NPI: 1821223900
Provider Name (Legal Business Name): SARAH KRISTINE DVORAK CCNS, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH KRISTINE PROCHASKA APRN, CCNS

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 WALTER REED RD
FAYETTEVILLE NC
28304-4437
US

IV. Provider business mailing address

935 WHISPERING PINES DR
SPRING LAKE NC
28390-9327
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-8718
  • Fax: 910-703-8721
Mailing address:
  • Phone: 910-814-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0083426
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number284789
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83426
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number83426
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number284789
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: