Individual
DIANA ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4972 LAKE HARBOR RD, NORTON SHORES, MI 49441-5272
(231) 720-8986
Mailing address
4972 LAKE HARBOR RD, NORTON SHORES, MI 49441-5272
(231) 720-8986
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
7979158
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7979158
PROVIDER ID
MI
Enumeration date
06/01/2016
Last updated
06/01/2016
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