Healthcare Provider Details

I. General information

NPI: 1770409328
Provider Name (Legal Business Name): IVANA CVETKOVIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
UTICA NY
13502-2517
US

IV. Provider business mailing address

11 FLOYD ST
NEW YORK MILLS NY
13417-1001
US

V. Phone/Fax

Practice location:
  • Phone: 708-704-6936
  • Fax:
Mailing address:
  • Phone: 315-941-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359972-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: