Healthcare Provider Details

I. General information

NPI: 1619885399
Provider Name (Legal Business Name): BESIM HUKIC RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 MAGNOLIA WAY
PEVELY MO
63070-1338
US

IV. Provider business mailing address

1969 MAGNOLIA WAY
PEVELY MO
63070-1338
US

V. Phone/Fax

Practice location:
  • Phone: 814-790-0768
  • Fax:
Mailing address:
  • Phone: 814-790-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN717911
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: