Healthcare Provider Details

I. General information

NPI: 1588366736
Provider Name (Legal Business Name): LIDIJA DJOLEVIC RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLUERIDGE AVE STE 210
WHEATON MD
20902-4517
US

IV. Provider business mailing address

2401 BLUERIDGE AVE STE 210
WHEATON MD
20902-4517
US

V. Phone/Fax

Practice location:
  • Phone: 240-514-1907
  • Fax:
Mailing address:
  • Phone: 240-514-1907
  • Fax: 301-933-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL147476
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: