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NPI Code Detail

MEDICARE: MRS. JANUARY DAWN IVANCIC

MEDICARE: MRS. JANUARY DAWN IVANCIC
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
1207RI0200XInfectious Disease Physician1093395139TX
2363LF0000XFamily Nurse Practitioner1137078TX

General Provider Information

NPI Number : 1730868993
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JANUARY DAWN IVANCIC
Provider Business Mailing Address
First Line : 156 SAND DRIFT PL
Second Line :
City : EL PASO
State : TX
Zip : 79928-9113
Country : US
Telephone Number : 915-400-8583
Fax Number :
Provider Business Practice Location Address
First Line : 1205 N OREGON ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-4023
Country : US
Telephone Number : 915-533-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2023
Last Update Date : 10/06/2023

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Directions to “ MRS. JANUARY DAWN IVANCIC ” Practice Location

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