Healthcare Provider Details

I. General information

NPI: 1992326151
Provider Name (Legal Business Name): DIANNA HUTTUNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

IV. Provider business mailing address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-4875
  • Fax: 815-748-1190
Mailing address:
  • Phone: 815-756-4875
  • Fax: 815-748-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: