Provider Demographics
NPI:1811759145
Name:YOUSIF, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:YOUSIF
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 1:36902 ALMONT DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4618
Mailing Address - Country:US
Mailing Address - Phone:586-480-7015
Mailing Address - Fax:
Practice Address - Street 1:36902 ALMONT DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4618
Practice Address - Country:US
Practice Address - Phone:586-480-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5251294Medicaid