Organization
BEAUMONT HEALTH
Active
Organization
BEAUMONT HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE PEARL NP (NURSE PRACTITIONER)
(313) 570-7906
Entity
Organization
Contact information
Practice address
15777 NORTHLINE, SOUTHGATE, MI 48195
(313) 570-7906
Mailing address
17801 SNOW, DEARBORN, MI 48124
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4704208352
MI
Other
Enumeration date
12/30/2016
Last updated
12/30/2016
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