Provider Demographics
NPI:1831480573
Name:DESSIEUX, OLIVERA LUKAJIC
Entity Type:Individual
Prefix:
First Name:OLIVERA
Middle Name:LUKAJIC
Last Name:DESSIEUX
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:PO BOX 59002
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-9002
Mailing Address - Country:US
Mailing Address - Phone:865-588-5121
Mailing Address - Fax:865-588-5126
Practice Address - Street 1:1311 DOWELL SPRINGS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2454
Practice Address - Country:US
Practice Address - Phone:865-588-5121
Practice Address - Fax:865-588-5126
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525862Medicaid
TN1525862Medicaid