Provider Demographics
NPI:1043432107
Name:DJORDJEVIC, KARAN RUTHERFORD (LPN)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:RUTHERFORD
Last Name:DJORDJEVIC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0701
Mailing Address - Country:US
Mailing Address - Phone:907-852-9312
Mailing Address - Fax:
Practice Address - Street 1:1296 AGVIK
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723-0701
Practice Address - Country:US
Practice Address - Phone:907-852-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse