Provider Demographics
NPI:1629736285
Name:SHALLCROSS, DIANE MARIE (APRN, FPA, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:SHALLCROSS
Suffix:
Gender:F
Credentials:APRN, FPA, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 STATE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1841
Mailing Address - Country:US
Mailing Address - Phone:847-341-0297
Mailing Address - Fax:
Practice Address - Street 1:218 STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1841
Practice Address - Country:US
Practice Address - Phone:815-893-9417
Practice Address - Fax:224-276-7254
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.003222363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health