Provider Demographics
NPI:1952073108
Name:DIGGS, MAVIS (RN)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:DIGGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 2ND AVE STE 266
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2675
Mailing Address - Country:US
Mailing Address - Phone:313-451-0405
Mailing Address - Fax:586-999-8836
Practice Address - Street 1:2727 2ND AVE STE 266
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2675
Practice Address - Country:US
Practice Address - Phone:313-451-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704347831163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse