Provider Demographics
NPI:1275188146
Name:COLON, IVA MARIJA PETROVCHICH (RN)
Entity Type:Individual
Prefix:
First Name:IVA
Middle Name:MARIJA PETROVCHICH
Last Name:COLON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IVA
Other - Middle Name:MARIJA
Other - Last Name:PETROVCHICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1825 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2350
Mailing Address - Country:US
Mailing Address - Phone:415-476-4616
Mailing Address - Fax:415-353-7107
Practice Address - Street 1:1825 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2350
Practice Address - Country:US
Practice Address - Phone:415-476-4616
Practice Address - Fax:415-353-7107
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95138547163W00000X
CA95012389363L00000X
CANP95012389363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner