Provider Demographics
NPI:1619270725
Name:DIGGS, ANNETTE NAOMI (RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:NAOMI
Last Name:DIGGS
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7638 S EVANS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2519
Mailing Address - Country:US
Mailing Address - Phone:773-559-0393
Mailing Address - Fax:
Practice Address - Street 1:7638 S EVANS AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2519
Practice Address - Country:US
Practice Address - Phone:773-559-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041376323163W00000X
IL209.021291363L00000X, 363LP0808X
MI4704365395363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner