Healthcare Provider Details

I. General information

NPI: 1588097687
Provider Name (Legal Business Name): DIJANA DUVALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIJANA MANOJLOVIC NP-C

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 REGENCY RD
LEXINGTON KY
40503-2954
US

IV. Provider business mailing address

PO BOX 737100
CHICAGO IL
60673-6374
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-1316
  • Fax: 859-276-3847
Mailing address:
  • Phone: 317-706-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008192
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: