Individual
NICOLETTE LINEA STEVANOVSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 NE A ST STE 100, MADRAS, OR 97741-1842
(541) 383-3005
(541) 383-1883
Mailing address
2827 MABLE COUCH WAY, KNOXVILLE, TN 37931-4284
(248) 860-5913
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA220456
OR
Other
Enumeration date
01/25/2024
Last updated
07/11/2024
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