Provider Demographics
NPI:1235601188
Name:BALBARIN, DIANA (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BALBARIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 W CATALPA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3216
Mailing Address - Country:US
Mailing Address - Phone:847-312-0333
Mailing Address - Fax:
Practice Address - Street 1:500 W CENTRAL RD STE 204
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2381
Practice Address - Country:US
Practice Address - Phone:847-376-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018528363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology