Provider Demographics
NPI:1235495581
Name:DURAKOVIC, SELMA
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:
Last Name:DURAKOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EAST GRANT STREET 606
Mailing Address - Street 2:
Mailing Address - City:MINNAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:401-714-5448
Mailing Address - Fax:
Practice Address - Street 1:500 E GRANT ST APT 606
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1433
Practice Address - Country:US
Practice Address - Phone:401-714-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program