Provider Demographics
NPI:1396077970
Name:BLOWERS, DIANE L (PA)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:BLOWERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S517 WINFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3159
Mailing Address - Country:US
Mailing Address - Phone:630-836-9121
Mailing Address - Fax:630-836-9126
Practice Address - Street 1:3S517 WINFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3159
Practice Address - Country:US
Practice Address - Phone:630-836-9121
Practice Address - Fax:630-836-9126
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003617363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical