Provider Demographics
NPI:1376288803
Name:DIAB, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DIAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 W NORMANTOWN RD APT 3213
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4352
Mailing Address - Country:US
Mailing Address - Phone:708-308-9339
Mailing Address - Fax:
Practice Address - Street 1:1157 W NORMANTOWN RD APT 3213
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4352
Practice Address - Country:US
Practice Address - Phone:708-308-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.455359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse