Provider Demographics
NPI:1255832424
Name:HESKIN, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HESKIN
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 1:8715 W MADISON DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2323
Mailing Address - Country:US
Mailing Address - Phone:773-350-4756
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 2-24
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3186
Practice Address - Country:US
Practice Address - Phone:847-825-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily