Provider Demographics
NPI:1023339140
Name:HADRAVA, EMILY MARIE (RN, CNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:HADRAVA
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 5TH ST SE
Mailing Address - Street 2:COOK AREA HEALTH SERVICES, INC
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723-9702
Mailing Address - Country:US
Mailing Address - Phone:218-666-5941
Mailing Address - Fax:
Practice Address - Street 1:415 N 2ND ST SUITE 2
Practice Address - Street 2:COOK AREA HEALTH SERVICES, INC
Practice Address - City:TOWER
Practice Address - State:MN
Practice Address - Zip Code:55790
Practice Address - Country:US
Practice Address - Phone:218-666-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR172344-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily