Provider Demographics
NPI:1912788472
Name:NENOV, DEJAN
Entity Type:Individual
Prefix:
First Name:DEJAN
Middle Name:
Last Name:NENOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W BOBWHITE CT STE 120
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6655
Mailing Address - Country:US
Mailing Address - Phone:415-999-4450
Mailing Address - Fax:
Practice Address - Street 1:250 W BOBWHITE CT STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6655
Practice Address - Country:US
Practice Address - Phone:415-999-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder