Provider Demographics
NPI:1831685767
Name:NURKANOVIC, MIRSADA (DNP, FNP)
Entity type:Individual
Prefix:
First Name:MIRSADA
Middle Name:
Last Name:NURKANOVIC
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:MIRSADA
Other - Middle Name:
Other - Last Name:IBRAHIMOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2064
Mailing Address - Country:US
Mailing Address - Phone:802-999-9343
Mailing Address - Fax:
Practice Address - Street 1:586 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7103
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily