Provider Demographics
NPI:1881116481
Name:DOUCETTE, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DOUCETTE
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 1:25680 CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1739
Mailing Address - Country:US
Mailing Address - Phone:248-910-4467
Mailing Address - Fax:
Practice Address - Street 1:2460 GEORGELAND DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3744
Practice Address - Country:US
Practice Address - Phone:248-673-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care