=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457819575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDIRA DJELOVIC HASANGJEKAJ FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2019
-----------------------------------------------------
Last Update Date | 12/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 LOCUST AVE
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-6148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-739-7029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 WHIPSTICK RD
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06877-5009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-833-2552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 10172
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F342674
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------