Provider Demographics
NPI:1033431580
Name:OAKLEY, DIANA L (APN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-238-6055
Mailing Address - Fax:
Practice Address - Street 1:1005 HEALTH CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4637
Practice Address - Country:US
Practice Address - Phone:217-258-2178
Practice Address - Fax:217-258-4024
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008054OtherILLINOIS DIVISION OF PROFESSIONAL REGULATION