Healthcare Provider Details

I. General information

NPI: 1508315565
Provider Name (Legal Business Name): SHIRLEY DIAMOND-HOLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E JOLLY RD APT B8
LANSING MI
48910-6683
US

IV. Provider business mailing address

101 E JOLLY RD APT B8
LANSING MI
48910-6683
US

V. Phone/Fax

Practice location:
  • Phone: 517-410-6252
  • Fax:
Mailing address:
  • Phone: 517-410-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: