Individual
AMIRA DERVISEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 587-3270
Mailing address
6239 W DINSMORE WAY, WEST JORDAN, UT 84081-4129
(801) 815-5125
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
7800211-3102
UT
Other
Enumeration date
08/17/2021
Last updated
12/20/2021
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