Individual
DIANE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1676 VIEWPOND DR SE, SUITE 100A, KENTWOOD, MI 49508-4994
(616) 455-9450
(616) 455-5221
Mailing address
1676 VIEWPOND DR SE, SUITE 100A, KENTWOOD, MI 49508-4994
(616) 455-9450
(616) 455-9450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704101913
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598853608
GROUP NPI - JOHN N CAMPBELL MD PC
—
05
—
4849371
—
MI
Enumeration date
07/25/2006
Last updated
11/15/2010
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