Provider Demographics
NPI:1225865389
Name:STOJANOVIC, JELENA
Entity type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:STOJANOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7267 W ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6635
Mailing Address - Country:US
Mailing Address - Phone:602-418-7874
Mailing Address - Fax:
Practice Address - Street 1:7267 W ANDREA DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-6635
Practice Address - Country:US
Practice Address - Phone:602-419-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-315221163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant