Provider Demographics
NPI:1730653973
Name:DIAZ, DANNY LISBETH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:LISBETH
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43155 MAIN ST STE 2316
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1781
Mailing Address - Country:US
Mailing Address - Phone:248-934-0274
Mailing Address - Fax:
Practice Address - Street 1:43155 MAIN ST STE 2316
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1781
Practice Address - Country:US
Practice Address - Phone:248-934-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704284519OtherRN LICENSE