Provider Demographics
NPI:1205636529
Name:DIEMER, ERIN NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:DIEMER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 RAYMOND DR APT 201
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2284
Mailing Address - Country:US
Mailing Address - Phone:317-512-7614
Mailing Address - Fax:
Practice Address - Street 1:620 N RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8950
Practice Address - Country:US
Practice Address - Phone:630-355-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085011119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant