Provider Demographics
NPI:1568358802
Name:PETROVIC, VESNA (LAC, DACCHM)
Entity type:Individual
Prefix:
First Name:VESNA
Middle Name:
Last Name:PETROVIC
Suffix:
Gender:F
Credentials:LAC, DACCHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 AUDUBON DR STE C
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5836
Mailing Address - Country:US
Mailing Address - Phone:501-680-8678
Mailing Address - Fax:
Practice Address - Street 1:2 VAN CIR STE 1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5273
Practice Address - Country:US
Practice Address - Phone:501-680-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR099171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist