Individual
ARIEL DIMITRIJEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 389-2377
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200443-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
10198-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100104040
—
WI
Enumeration date
04/15/2020
Last updated
12/01/2021
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