Provider Demographics
NPI:1275764128
Name:SLAGER, DIANNE (FNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:SLAGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4800
Mailing Address - Country:US
Mailing Address - Phone:616-249-0159
Mailing Address - Fax:616-249-8688
Practice Address - Street 1:4415 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49519-4800
Practice Address - Country:US
Practice Address - Phone:616-249-0159
Practice Address - Fax:616-249-8688
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704137301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily