Provider Demographics
NPI:1558043893
Name:BURKE, DIANA N (APN/FNP)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:N
Last Name:BURKE
Suffix:
Gender:F
Credentials:APN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735376
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5376
Mailing Address - Country:US
Mailing Address - Phone:184-771-4720
Mailing Address - Fax:
Practice Address - Street 1:901 S AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5311
Practice Address - Country:US
Practice Address - Phone:773-287-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023020237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily