Provider Demographics
NPI:1730868993
Name:IVANCIC, JANUARY DAWN
Entity type:Individual
Prefix:MRS
First Name:JANUARY
Middle Name:DAWN
Last Name:IVANCIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANUARY
Other - Middle Name:DAWN
Other - Last Name:LOVETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 SAND DRIFT PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-9113
Mailing Address - Country:US
Mailing Address - Phone:915-400-8583
Mailing Address - Fax:
Practice Address - Street 1:1205 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4023
Practice Address - Country:US
Practice Address - Phone:915-533-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1093395139207RI0200X
TX1137078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease