Provider Demographics
NPI:1427047299
Name:PAVELKA, JULIA M (APRN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:PAVELKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W 2ND ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4684
Mailing Address - Country:US
Mailing Address - Phone:402-463-1250
Mailing Address - Fax:402-463-1461
Practice Address - Street 1:2727 W 2ND ST
Practice Address - Street 2:SUITE 340
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4684
Practice Address - Country:US
Practice Address - Phone:402-463-1250
Practice Address - Fax:402-463-1461
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE110642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q25718Medicare UPIN
278176Medicare ID - Type Unspecified