Provider Demographics
NPI:1588366736
Name:DJOLEVIC, LIDIJA (RN IBCLC)
Entity type:Individual
Prefix:
First Name:LIDIJA
Middle Name:
Last Name:DJOLEVIC
Suffix:
Gender:F
Credentials:RN IBCLC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 BLUERIDGE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4517
Mailing Address - Country:US
Mailing Address - Phone:240-514-1907
Mailing Address - Fax:301-933-5087
Practice Address - Street 1:2401 BLUERIDGE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4517
Practice Address - Country:US
Practice Address - Phone:240-514-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL147476163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant