Provider Demographics
NPI:1114411857
Name:CARLTON, DIANA COYOTL
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:COYOTL
Last Name:CARLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8893 STONEPOINT CT
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8643
Mailing Address - Country:US
Mailing Address - Phone:616-914-7169
Mailing Address - Fax:
Practice Address - Street 1:8893 STONEPOINT CT
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8643
Practice Address - Country:US
Practice Address - Phone:616-914-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information