Individual
MR. DUSTIN BRANT IVANIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
3255 S RURAL RD, TEMPE, AZ 85282-3853
(480) 304-5467
Mailing address
2620 ELM HILL PIKE, NASHVILLE, TN 37214-3108
(615) 425-4200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP9722
AZ
Other
Enumeration date
02/20/2017
Last updated
02/20/2017
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