Individual
DIANA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
227 E SANILAC RD, SANDUSKY, MI 48471-1160
(810) 648-0330
Mailing address
2190 PHIPPS RD, CARSONVILLE, MI 48419-9259
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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