Provider Demographics
NPI:1164780276
Name:DJURIC, CORINNE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:MICHELLE
Last Name:DJURIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-6006
Mailing Address - Country:US
Mailing Address - Phone:219-956-3004
Mailing Address - Fax:219-956-3006
Practice Address - Street 1:165 E ROBBINS ST
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:IN
Practice Address - Zip Code:46392-6006
Practice Address - Country:US
Practice Address - Phone:219-956-3004
Practice Address - Fax:219-956-3006
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003937A363LF0000X
IN28158749A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily