Healthcare Provider Details

I. General information

NPI: 1902530363
Provider Name (Legal Business Name): ALMERISA DZANANOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N STAEBLER RD STE B
ANN ARBOR MI
48103-9862
US

IV. Provider business mailing address

5033 CAMPUS HILL DR APT H301
OKEMOS MI
48864-1452
US

V. Phone/Fax

Practice location:
  • Phone: 734-252-6522
  • Fax:
Mailing address:
  • Phone: 517-402-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: