Individual
MRS. DIANA LYNNE ELLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
26184 OUTER DR, LINCOLN PARK, MI 48146-2084
(313) 389-7533
(313) 389-2956
Mailing address
9340 ELM ST, TAYLOR, MI 48180-3484
(313) 291-7355
(313) 389-2956
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
4704201384
MI
Other
Enumeration date
06/05/2007
Last updated
07/08/2007
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