Organization
ST GEORGE CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TATJANA STEVANOVIC NP (ADULT NURSE PRACTIONER)
(262) 923-3777
Entity
Organization
Contact information
Practice address
308 E MAIN ST, WATERFORD, WI 53185-4306
(262) 923-3777
Mailing address
308 E MAIN ST, WATERFORD, WI 53185-4306
(262) 923-3777
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
52D1037628
WI
261QM1300X
Multi-Specialty Clinic/Center
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Other
Enumeration date
05/22/2018
Last updated
11/20/2023
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