Provider Demographics
NPI:1902215130
Name:VENT, DIANE KATHERINE (RN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:KATHERINE
Last Name:VENT
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:KATHERINE
Other - Last Name:GONSIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP-C
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-6163
Practice Address - Fax:312-563-2096
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011636363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care