Provider Demographics
NPI:1851309645
Name:DUDAS SHEEHAN, DIANE (CNP, APN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DUDAS SHEEHAN
Suffix:
Gender:F
Credentials:CNP, APN
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:DUDAS SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP, APN
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 69
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6624
Mailing Address - Fax:312-227-9404
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 69
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6624
Practice Address - Fax:312-227-9404
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001176363L00000X, 363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00222141OtherRAILROAD MEDICARE
IL200718Medicare PIN
ILK01236Medicare PIN
P38319Medicare UPIN
ILK01234Medicare PIN