Individual ProviderCora Leah DziukNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address448 Castroville Rd, San Antonio, TX 78207-5147(210) 434-1400PECOS EnrollmentBased on the most recent information from CMS, provider Cora Leah Dziuk does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1184925356Provider TypeIndividualFull NameDziuk, Cora LeahCredentialRN, MSN, NP-CGenderFemaleSole ProprietorNoEnumeration Date11/4/2010Last Updated1/28/2019Contact InformationPractice LocationPractice Address448 Castroville Rd, San Antonio, TX 78207-5147Phone(210) 434-1400Fax(210) 431-7472Mailing LocationMailing Address448 Castroville Rd, San Antonio, TX 78207-5147Phone(210) 434-1400Fax(210) 431-7472Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense669986TexasProvider IdentifiersIDDescriptionIssuerID261129YL9SDescriptionOtherIssuerWELLMED MEDICAL GROUP PATexasID122502308DescriptionOtherIssuerCAQHTexasID313361301DescriptionOtherIssuerWELLMED MEDICAIDTexas