Provider Demographics
NPI:1477204279
Name:DVORAK, MICHELE R (RN, MA, BSN, CCM)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:R
Last Name:DVORAK
Suffix:
Gender:F
Credentials:RN, MA, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 DAWSON MANOR CT
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6031
Mailing Address - Country:US
Mailing Address - Phone:404-272-3080
Mailing Address - Fax:770-777-6474
Practice Address - Street 1:86 DAWSON MANOR CT
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6031
Practice Address - Country:US
Practice Address - Phone:404-272-3080
Practice Address - Fax:770-777-6474
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN098411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse