Provider Demographics
NPI:1487002853
Name:DVORAK, JILL (RN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:DVORAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1036
Mailing Address - Country:US
Mailing Address - Phone:605-428-5473
Mailing Address - Fax:605-428-5609
Practice Address - Street 1:1216 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1036
Practice Address - Country:US
Practice Address - Phone:605-428-5473
Practice Address - Fax:605-428-5609
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RNR031740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse