Provider Demographics
NPI:1821580077
Name:PAVELKA, MELVA
Entity Type:Individual
Prefix:
First Name:MELVA
Middle Name:
Last Name:PAVELKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELVA
Other - Middle Name:
Other - Last Name:CONSBRUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4111 4TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2883
Mailing Address - Country:US
Mailing Address - Phone:308-237-1102
Mailing Address - Fax:308-234-5712
Practice Address - Street 1:4111 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2883
Practice Address - Country:US
Practice Address - Phone:308-237-1102
Practice Address - Fax:308-234-5712
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist