Individual
MRS. DIANE MARIE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1045 E FRONT ST, BUCHANAN, MI 49107-8474
(269) 695-5540
(269) 695-0412
Mailing address
8665 GEORGE AVE, BERRIEN SPRINGS, MI 49103-1409
(269) 471-4902
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28138958A
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4511986
—
MI
Enumeration date
08/03/2006
Last updated
07/08/2007
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