Individual
DIANE STOLLER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
707 SANDRA CT, DEARBORN HEIGHTS, MI 48127-4137
(313) 274-5061
(248) 357-0915
Mailing address
707 SANDRA CT, DEARBORN HEIGHTS, MI 48127-4137
(313) 274-5061
(248) 357-0915
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704091295
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS091295
BCBSM NUMBER
MI
Enumeration date
06/12/2006
Last updated
07/08/2007
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