Provider Demographics
NPI:1134894348
Name:HAKIM-TAILA, DIANA (NP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:HAKIM-TAILA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:HAKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31500 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1057
Mailing Address - Country:US
Mailing Address - Phone:586-939-9500
Mailing Address - Fax:
Practice Address - Street 1:31500 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1057
Practice Address - Country:US
Practice Address - Phone:586-939-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704329236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily