Provider Demographics
NPI:1396874145
Name:DVORAK, JULIE A (CDE)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:DVORAK
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 N SOCORA ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3279
Mailing Address - Country:US
Mailing Address - Phone:316-440-2802
Mailing Address - Fax:316-440-2809
Practice Address - Street 1:834 N SOCORA ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3279
Practice Address - Country:US
Practice Address - Phone:316-440-2802
Practice Address - Fax:316-440-2809
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1376200012163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10528Medicare ID - Type Unspecified