MEDICARE: IRMA SULEJMANOVIC-BORDEAUX APRN-NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	201901673	OR

General Provider Information

NPI Number	:	1902238553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMA SULEJMANOVIC-BORDEAUX APRN-NP

Provider Business Mailing Address
First Line	:	1130 NW 22ND AVE STE 320
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2970
Country	:	US
Telephone Number	:	503-295-2546
Fax Number	:	503-790-1248

Provider Business Practice Location Address
First Line	:	1130 NW 22ND AVE STE 320
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2970
Country	:	US
Telephone Number	:	503-295-2546
Fax Number	:	503-790-1248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	06/08/2026

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Directions to “ IRMA SULEJMANOVIC-BORDEAUX APRN-NP” Practice Location

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