Individual
ANITA DERVISEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3136 ONEIDA ST, SAUQUOIT, NY 13456-2800
(315) 737-3522
Mailing address
1006 BELMONT AVE, UTICA, NY 13501-3210
(315) 939-0214
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
343098
NY
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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