Provider Demographics
NPI:1174279384
Name:OTASEVIC, NADA
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:OTASEVIC
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 1:4213 28TH AVE APT E4
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2838
Mailing Address - Country:US
Mailing Address - Phone:917-833-0476
Mailing Address - Fax:
Practice Address - Street 1:4213 28TH AVE APT E4
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2838
Practice Address - Country:US
Practice Address - Phone:917-833-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse