MEDICARE: EMILY MARIE HADRAVA RN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R172344-1	MN

General Provider Information

NPI Number	:	1023339140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MARIE HADRAVA RN, CNP

Provider Business Mailing Address
First Line	:	20 5TH ST SE
Second Line	:	COOK AREA HEALTH SERVICES, INC
City	:	COOK
State	:	MN
Zip	:	55723-9702
Country	:	US
Telephone Number	:	218-666-5941
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N 2ND ST SUITE 2
Second Line	:	COOK AREA HEALTH SERVICES, INC
City	:	TOWER
State	:	MN
Zip	:	55790
Country	:	US
Telephone Number	:	218-666-5941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	12/28/2016

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