Provider Demographics
NPI:1992563464
Name:SULJIC, INDIRA
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:SULJIC
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 1:850 BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4794
Mailing Address - Country:US
Mailing Address - Phone:503-553-9096
Mailing Address - Fax:
Practice Address - Street 1:850 BROADMOOR AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4794
Practice Address - Country:US
Practice Address - Phone:503-553-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant