Individual
THERESA A JOVANOVICH
Active
Individual
THERESA A JOVANOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10004066
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039594
LABOR AND INDUSTRIES #
WA
01
—
0335JO
BLUE SHIELD #
WA
05
—
8362543
—
WA
01
—
970030800
RAILROAD MC#
WA
01
—
US7233432
AETNA SPECIALIST PIN
WA
Enumeration date
01/09/2007
Last updated
12/31/2012
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