Provider Demographics
NPI:1588193700
Name:VIZCAYNO, DIANA LOU (FNP)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:LOU
Last Name:VIZCAYNO
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 1:936 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6822
Mailing Address - Country:US
Mailing Address - Phone:847-291-3596
Mailing Address - Fax:
Practice Address - Street 1:936 WILLOW RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6822
Practice Address - Country:US
Practice Address - Phone:847-291-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily