Healthcare Provider Details

I. General information

NPI: 1013828409
Provider Name (Legal Business Name): GRACE DIANNE DEFRINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W SURF ST STE 907
CHICAGO IL
60657-7227
US

IV. Provider business mailing address

331 W SURF ST STE 907
CHICAGO IL
60657-7227
US

V. Phone/Fax

Practice location:
  • Phone: 773-755-2600
  • Fax: 773-880-0403
Mailing address:
  • Phone: 773-755-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041572586
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209036584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: