Individual
DIANE PEARL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15777 NORTHLINE RD, SOUTHGATE, MI 48195-2385
(313) 586-5641
Mailing address
17801 SNOW AVE, DEARBORN, MI 48124-4306
(313) 570-7906
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704208352
MI
Other
Enumeration date
02/09/2017
Last updated
12/07/2021
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