Individual
NATALIA DIIACOVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
43825 MICHIGAN AVE, CANTON, MI 48188-2551
(734) 397-3088
Mailing address
47125 STONECREST DR, PLYMOUTH, MI 48170-3432
(734) 474-5656
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704352369
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704352369
MI
Other
Enumeration date
04/17/2021
Last updated
10/05/2023
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