Individual
SUSAN J DVORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1000 S COLUMBIA RD, GRAND FORKS, ND 58201-4036
(701) 780-5345
(701) 780-1942
Mailing address
PO BOX 6002, GRAND FORKS, ND 58206-6002
(701) 780-5345
(701) 780-1942
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0353
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11ND1DV
BCBS MN
MN
01
—
27352
BCBS ND
ND
Enumeration date
11/30/2006
Last updated
07/08/2007
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