Doctor Name: | KORIE KAE PRAVECEK |
NPI Number: | 1477969657 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | CP000870 |
Business Practice Address: | 825 E 8th St Suite 1 Winner, SD - 575802634 |
Business Phone Number: | 6058422626 |
Business Fax Number: | |
Mailing Address: | 28260 318th Ave, COLOME |
State: | SD |
Postal Code: | 575286412 |
Phone Number: | 6058400166 |
Fax Number: | |
NPI Enumeration Date: | 07/08/2014 |
NPI Last Update Date: | 10/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CP000870 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |