Provider Demographics
NPI:1790045573
Name:DIAMANRE, MARIA GRACE (RN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GRACE
Last Name:DIAMANRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10141 WEHRMAN PL APT C
Mailing Address - Street 2:
Mailing Address - City:SCHILLER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60176-2059
Mailing Address - Country:US
Mailing Address - Phone:773-599-7039
Mailing Address - Fax:
Practice Address - Street 1:10141 WEHRMAN PL APT C
Practice Address - Street 2:
Practice Address - City:SCHILLER PARK
Practice Address - State:IL
Practice Address - Zip Code:60176-2059
Practice Address - Country:US
Practice Address - Phone:773-599-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.267787163WC1600X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.267787OtherREGISTERED NURSE