Provider Demographics
NPI:1134213028
Name:SPOLJORIC, DIANE E (FNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:SPOLJORIC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 W JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-6548
Mailing Address - Country:US
Mailing Address - Phone:219-326-7337
Mailing Address - Fax:219-814-4228
Practice Address - Street 1:6916 W JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-6548
Practice Address - Country:US
Practice Address - Phone:219-326-7337
Practice Address - Fax:219-814-4228
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000170A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233460AMedicaid
IN151020BBBBMedicare PIN
INS89605Medicare UPIN