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Individual

KELLY JO DIAZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CMA AAMA

Contact information

Practice address
4922 PORT SHELDON ST, HUDSONVILLE, MI 49426-8927
(616) 308-9142
Mailing address
4922 PORT SHELDON ST, HUDSONVILLE, MI 49426-8927
(616) 308-9142

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
00000000000000
MI
376K00000X
Nurse's Aide
Primary
MI

Other

Enumeration date
02/17/2020
Last updated
02/17/2020
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