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Individual
MIA IVANCOVICH
Active
Individual
MIA IVANCOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
813227-01
NY
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
813227-01
NY
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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