Milica Ivanov, NP
Nurse Practitioner, Family in Dyer, IN. Individual provider (NPI-1).
NPI number1003551979
StatusActive
Last updated in NPPESMay 4, 2022
Details
- NPI
- 1003551979
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Milica Ivanov
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 4, 2022
- Certification date
- Mar 19, 2022
- Last updated
- May 4, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 71012485A | IN | Yes |
Practice location
1532 Calumet AveDyer, IN 46311-1588
Phone 219-515-4700
Mailing address
10110 Donald S Powers DrSuite 101d
Munster, IN 46321
Phone 219-301-7264
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