Healthcare Provider Details

I. General information

NPI: 1619709656
Provider Name (Legal Business Name): LIBERTI-KRISHNAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

IV. Provider business mailing address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

V. Phone/Fax

Practice location:
  • Phone: 312-736-2865
  • Fax: 630-761-7549
Mailing address:
  • Phone: 312-736-2865
  • Fax: 630-761-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANA C KRISHNAN
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: APRN, PMHNP
Phone: 312-736-2865