Provider Demographics
NPI:1073745923
Name:DIMOND, DEBORAH LYNN (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:DIMOND
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9244 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1757
Mailing Address - Country:US
Mailing Address - Phone:810-653-2111
Mailing Address - Fax:810-653-8506
Practice Address - Street 1:9244 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1757
Practice Address - Country:US
Practice Address - Phone:810-653-2111
Practice Address - Fax:810-653-8506
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704226244363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health