Healthcare Provider Details

I. General information

NPI: 1164780276
Provider Name (Legal Business Name): CORINNE MICHELLE DJURIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E ROBBINS ST
WHEATFIELD IN
46392-6006
US

IV. Provider business mailing address

165 E ROBBINS ST
WHEATFIELD IN
46392-6006
US

V. Phone/Fax

Practice location:
  • Phone: 219-956-3004
  • Fax: 219-956-3006
Mailing address:
  • Phone: 219-956-3004
  • Fax: 219-956-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003937A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28158749A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: