Provider Demographics
NPI:1518208156
Name:DRAVECKY, JESSICA WURTZ (CD(DONA))
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:WURTZ
Last Name:DRAVECKY
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:HOTCHKISS
Mailing Address - State:CO
Mailing Address - Zip Code:81419-0927
Mailing Address - Country:US
Mailing Address - Phone:719-439-9957
Mailing Address - Fax:
Practice Address - Street 1:285 4TH ST
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419-9318
Practice Address - Country:US
Practice Address - Phone:719-439-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula