Provider Demographics
NPI:1831995281
Name:DEJAN DUKIC PMHNP- BC
Entity type:Organization
Organization Name:DEJAN DUKIC PMHNP- BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKIC
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:520-742-9166
Mailing Address - Street 1:7410 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2306
Mailing Address - Country:US
Mailing Address - Phone:520-742-9166
Mailing Address - Fax:520-742-9146
Practice Address - Street 1:7410 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2306
Practice Address - Country:US
Practice Address - Phone:520-742-9166
Practice Address - Fax:520-742-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty