Provider Demographics
NPI:1134593635
Name:DIAZ, DARLEEN N/A (MSN, RN, APN, FNP-PC)
Entity type:Individual
Prefix:MRS
First Name:DARLEEN
Middle Name:N/A
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSN, RN, APN, FNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 ELM ST
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1618
Mailing Address - Country:US
Mailing Address - Phone:312-860-8566
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013407363LF0000X
IL277.000784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily