Provider Demographics
NPI:1871974220
Name:VIDIC, SUZANA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUZANA
Middle Name:
Last Name:VIDIC
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SUZANA
Other - Middle Name:
Other - Last Name:TODOROVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6134 TIMBERLINE PLACE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-4208
Mailing Address - Country:US
Mailing Address - Phone:314-606-9677
Mailing Address - Fax:314-722-3512
Practice Address - Street 1:1 BARNES JEW HOSP PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015011481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily