Provider Demographics
NPI:1558002717
Name:GILL, DIANNA LYN
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYN
Last Name:GILL
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 1:1322 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-2803
Mailing Address - Country:US
Mailing Address - Phone:810-329-4798
Mailing Address - Fax:
Practice Address - Street 1:1322 RIVER RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-2803
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator