Healthcare Provider Details

I. General information

NPI: 1225865389
Provider Name (Legal Business Name): JELENA STOJANOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7267 W ANDREA DR
PEORIA AZ
85383-6635
US

IV. Provider business mailing address

7267 W ANDREA DR
PEORIA AZ
85383-6635
US

V. Phone/Fax

Practice location:
  • Phone: 602-419-7874
  • Fax:
Mailing address:
  • Phone: 602-418-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-315221
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: