Provider Demographics
NPI:1164605770
Name:KOVACEVIC, LJILJANA (CRNA)
Entity Type:Individual
Prefix:
First Name:LJILJANA
Middle Name:
Last Name:KOVACEVIC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2944
Mailing Address - Country:US
Mailing Address - Phone:973-842-0464
Mailing Address - Fax:973-972-2357
Practice Address - Street 1:120 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2944
Practice Address - Country:US
Practice Address - Phone:973-842-0464
Practice Address - Fax:973-972-2357
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12027500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered