Healthcare Provider Details

I. General information

NPI: 1548715527
Provider Name (Legal Business Name): DIANE LYNN LEARMAN CNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 N RICHMOND RD
MCHENRY IL
60051-5407
US

IV. Provider business mailing address

2507 N RICHMOND RD STE A
MCHENRY IL
60051-5407
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-6600
  • Fax: 815-385-3255
Mailing address:
  • Phone: 815-344-2300
  • Fax: 815-344-8957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014258
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.014258
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: