Provider Demographics
NPI:1336700491
Name:DOBRAVA, ROXANNE JO (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:JO
Last Name:DOBRAVA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:MS
Other - First Name:ROXANNE
Other - Middle Name:JO
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8245 W BEATRICE DR
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-9464
Mailing Address - Country:US
Mailing Address - Phone:701-500-0794
Mailing Address - Fax:
Practice Address - Street 1:12 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHISHOLM
Practice Address - State:MN
Practice Address - Zip Code:55719-1817
Practice Address - Country:US
Practice Address - Phone:218-254-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2509054163W00000X
WY37941163W00000X
WY54319363LP0808X
MN11444363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse