Provider Demographics
NPI:1336695923
Name:EHLERT, DIANNA GRACE (MSN, RN, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:GRACE
Last Name:EHLERT
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP-BC
Other - Prefix:MISS
Other - First Name:DIANNA
Other - Middle Name:
Other - Last Name:PEERCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, AGACNP-BC
Mailing Address - Street 1:311 MACK AVE., STE 6411
Mailing Address - Street 2:VASCULAR SURGERY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2466
Mailing Address - Country:US
Mailing Address - Phone:734-682-3309
Mailing Address - Fax:
Practice Address - Street 1:311 MACK AVE STE 64100
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2466
Practice Address - Country:US
Practice Address - Phone:313-832-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301257163W00000X, 208VP0014X, 363LA2100X, 363LA2200X
NM65285163WC0200X, 363LA2100X
VA0024183682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care