Provider Demographics
NPI:1588071815
Name:DVORAK, KENDRA D (APRN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:D
Last Name:DVORAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:D
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1394
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1394
Mailing Address - Country:US
Mailing Address - Phone:402-564-1338
Mailing Address - Fax:402-564-8902
Practice Address - Street 1:4214 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1616
Practice Address - Country:US
Practice Address - Phone:402-564-1338
Practice Address - Fax:402-564-8902
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111673363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology