Provider Demographics
NPI:1770801243
Name:DVORAK, JANA (LMP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:DVORAK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19823 10TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7701
Mailing Address - Country:US
Mailing Address - Phone:425-487-2491
Mailing Address - Fax:
Practice Address - Street 1:19823 10TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7701
Practice Address - Country:US
Practice Address - Phone:425-487-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2010-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist