Healthcare Provider Details

I. General information

NPI: 1942170584
Provider Name (Legal Business Name): DIANA RAICHICI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 CHURCH ST STE 100
EVANSTON IL
60201-5910
US

IV. Provider business mailing address

1007 CHURCH ST STE 100
EVANSTON IL
60201-5910
US

V. Phone/Fax

Practice location:
  • Phone: 815-995-2776
  • Fax:
Mailing address:
  • Phone: 815-995-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209033609
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: