Provider Demographics
NPI:1215278221
Name:DVORAK, KATHRYN M (GCNS APNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:DVORAK
Suffix:
Gender:F
Credentials:GCNS APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 N GRANDVIEW BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1672
Mailing Address - Country:US
Mailing Address - Phone:262-513-0700
Mailing Address - Fax:262-513-0707
Practice Address - Street 1:2717 N GRANDVIEW BLVD
Practice Address - Street 2:STE 202
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1672
Practice Address - Country:US
Practice Address - Phone:262-513-0700
Practice Address - Fax:262-513-0707
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5248-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner