Provider Demographics
NPI:1417425349
Name:DRVARIC, MEREDITH L (DNP-FNP, FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:DRVARIC
Suffix:
Gender:F
Credentials:DNP-FNP, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2331
Mailing Address - Country:US
Mailing Address - Phone:414-277-5054
Mailing Address - Fax:414-456-6211
Practice Address - Street 1:1650 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2331
Practice Address - Country:US
Practice Address - Phone:414-277-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8869-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417425349Medicaid