Healthcare Provider Details

I. General information

NPI: 1154377588
Provider Name (Legal Business Name): DIANA OAKES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

541 N FAIRBANKS CT STE 1700
CHICAGO IL
60611-4644
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7970
  • Fax:
Mailing address:
  • Phone: 312-926-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-005459
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: