Healthcare Provider Details

I. General information

NPI: 1215520028
Provider Name (Legal Business Name): MAJA DJURIC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORTHVIEW RD
WAUKESHA WI
53188-1617
US

IV. Provider business mailing address

4986 S 92ND ST
MILWAUKEE WI
53228-3503
US

V. Phone/Fax

Practice location:
  • Phone: 262-797-9558
  • Fax:
Mailing address:
  • Phone: 414-870-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number251418-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: