Healthcare Provider Details

I. General information

NPI: 1891338216
Provider Name (Legal Business Name): DIANA CANO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 940
CHICAGO IL
60611-2945
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 940
CHICAGO IL
60611-2945
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-8358
  • Fax: 312-926-9630
Mailing address:
  • Phone: 312-926-8358
  • Fax: 312-926-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277005049
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020301
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: