Individual
DIANE MOULDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15200 W 8 MILE RD, OAK PARK, MI 48237-3048
(313) 427-4882
Mailing address
15200 W 8 MILE RD, OAK PARK, MI 48237-3048
(313) 427-4882
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703065467
MI
Other
Enumeration date
02/23/2016
Last updated
02/23/2016
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