Healthcare Provider Details

I. General information

NPI: 1588035653
Provider Name (Legal Business Name): DR. DIANA QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 MILLER RD
ANN ARBOR MI
48103-2122
US

IV. Provider business mailing address

3053 MILLER RD
ANN ARBOR MI
48103-2122
US

V. Phone/Fax

Practice location:
  • Phone: 734-221-0225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0108881
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: