| Doctor Name: | DIANA SCANLON |
| NPI Number: | 1043651458 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 4704267416 |
| Business Practice Address: | 45640 Schoenherr Rd Suite B Shelby Township, MI - 483156033 |
| Business Phone Number: | 5862474300 |
| Business Fax Number: | 5865326496 |
| Mailing Address: | 45640 Schoenherr Rd, Suite B SHELBY TOWNSHIP |
| State: | MI |
| Postal Code: | 483156033 |
| Phone Number: | 5862474300 |
| Fax Number: | 5865326496 |
| NPI Enumeration Date: | 07/13/2013 |
| NPI Last Update Date: | 10/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704267416 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |