Provider Demographics
NPI:1639353311
Name:CVIJIC, JOANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:CVIJIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11456 OLIVE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7101
Mailing Address - Country:US
Mailing Address - Phone:314-993-8233
Mailing Address - Fax:314-993-5323
Practice Address - Street 1:11456 OLIVE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7101
Practice Address - Country:US
Practice Address - Phone:314-993-8233
Practice Address - Fax:314-993-5323
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007026801363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical