Individual
MS. DIANTHA JEANNE SOARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4703 US NORTH 31, KEWADIN, MI 49648
(231) 463-0380
Mailing address
4703 US NORTH 31, KEWADIN, MI 49648
(231) 463-0380
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703089304
MI
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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