Healthcare Provider Details

I. General information

NPI: 1003431974
Provider Name (Legal Business Name): ALDIJANA BJELOBRKOVIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 N 19TH AVE STE 3
PHOENIX AZ
85015-4602
US

IV. Provider business mailing address

4350 N 19TH AVE STE 3
PHOENIX AZ
85015-4602
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-4975
  • Fax: 602-279-1108
Mailing address:
  • Phone: 602-279-4975
  • Fax: 602-279-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number242545
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: