Healthcare Provider Details

I. General information

NPI: 1346743077
Provider Name (Legal Business Name): JELENA OZEGOVIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 JOLIET ST STE 225
DYER IN
46311-1789
US

IV. Provider business mailing address

1861 STURDY RD
VALPARAISO IN
46383-8017
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-8800
  • Fax: 219-865-8908
Mailing address:
  • Phone: 219-548-0360
  • Fax: 219-548-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007841A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: