Individual
DEJAN NIKOLIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
401 MULBERRY ST SW STE 102, LENOIR, NC 28645-5463
(182) 875-7643
Mailing address
401 MULBERRY ST SW STE 102, LENOIR, NC 28645-5463
(182) 875-7643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-13100
NC
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
0010-13100
NC
Other
Enumeration date
03/03/2023
Last updated
03/06/2023
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