Healthcare Provider Details

I. General information

NPI: 1841690328
Provider Name (Legal Business Name): SARA DIANA MIRANDA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA DIANA ZAKARIAN

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LAKE ST
OAK PARK IL
60302-2606
US

IV. Provider business mailing address

14 LAKE ST
OAK PARK IL
60302-2606
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-0113
  • Fax: 708-383-0226
Mailing address:
  • Phone: 708-383-0113
  • Fax: 708-383-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: