MEDICARE: MS. DZENITA NUHANOVIC APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4011224	KY

General Provider Information

NPI Number	:	1649041617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DZENITA NUHANOVIC APRN

Provider Business Mailing Address
First Line	:	1007 RUNELL RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-4603
Country	:	US
Telephone Number	:	502-759-8146
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 HOWLE AVE STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	854-444-0518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/10/2024

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