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General NPI Number Information
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NPI Number | 1174335616
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Entity Type | Individual
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Provider Name | JOHN VAVRA
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Gender | Male
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 2501 W 22ND ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1305
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Country | US
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Telephone | 605-336-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 RIVER ASPEN RD
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City | YANKTON
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State | SD
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Zip | 57078-6868
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Country | US
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Telephone | 56-232-2795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | R029387
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License Number State | SD
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