Healthcare Provider Details

I. General information

NPI: 1588372627
Provider Name (Legal Business Name): DIANE KAY KERSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S DETROIT AVE
TOLEDO OH
43614-5903
US

IV. Provider business mailing address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

V. Phone/Fax

Practice location:
  • Phone: 419-259-2000
  • Fax: 419-213-7633
Mailing address:
  • Phone: 567-225-3702
  • Fax: 419-213-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number35-093681
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: