Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | DD062478 | MI |
NPI | 1366461212 |
---|---|
Provider Name | Dr. Diane K. Donley |
First Address | Traverse City, MI 49684-6852 |
Second Address | Traverse City, MI 49684-2340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A63221 | (02) | MI |