Healthcare Provider Details

I. General information

NPI: 1174391452
Provider Name (Legal Business Name): ABIGAIL DIEHL MSN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W BIG BEAVER RD STE 200
TROY MI
48084-3545
US

IV. Provider business mailing address

1449 LILA DR
TROY MI
48085-3406
US

V. Phone/Fax

Practice location:
  • Phone: 248-205-3535
  • Fax:
Mailing address:
  • Phone: 586-295-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704342890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: