Provider Demographics
NPI:1992765374
Name:JONES, DIANE J (PA-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:JONES
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5325 ELLIOTT DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8633
Mailing Address - Country:US
Mailing Address - Phone:734-712-7202
Mailing Address - Fax:734-712-8209
Practice Address - Street 1:5325 ELLIOTT DR
Practice Address - Street 2:SUITE #102
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-7202
Practice Address - Fax:734-712-8209
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-11-02
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Provider Licenses
StateLicense IDTaxonomies
MI5601001883363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical