Provider Demographics
NPI:1821223900
Name:DVORAK, SARAH KRISTINE (CCNS, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KRISTINE
Last Name:DVORAK
Suffix:
Gender:F
Credentials:CCNS, ARNP
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:KRISTINE
Other - Last Name:PROCHASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CCNS
Mailing Address - Street 1:935 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9327
Mailing Address - Country:US
Mailing Address - Phone:910-814-3116
Mailing Address - Fax:
Practice Address - Street 1:1207 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4437
Practice Address - Country:US
Practice Address - Phone:910-703-8718
Practice Address - Fax:910-703-8721
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0083426163W00000X
NC284789163W00000X, 363LF0000X
OK83426363LF0000X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200282900AMedicaid