Provider Demographics
NPI:1235190059
Name:MCBRIDE, DIANNA J (FNP)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:J
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3741
Mailing Address - Country:US
Mailing Address - Phone:312-572-4503
Mailing Address - Fax:312-572-4511
Practice Address - Street 1:1645 COTTAGE GROVE AVE
Practice Address - Street 2:COTTAGE GROVE HEALTH CENTER
Practice Address - City:FORD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3818
Practice Address - Country:US
Practice Address - Phone:708-753-5846
Practice Address - Fax:708-753-5042
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily