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General NPI Number Information
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NPI Number | 1235908229
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Entity Type | Individual
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Provider Name | DIANA KRISHNAN APRN, PMHNP-BC, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 661 W LAKE ST STE 2S
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City | CHICAGO
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State | IL
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Zip | 60661-1034
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Country | US
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Telephone | 312-736-2865
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Fax | 630-761-7549
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Provider Business Mailing Address
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Address Line | 661 W LAKE ST STE 2S
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City | CHICAGO
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State | IL
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Zip | 60661-1034
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Country | US
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Telephone | 312-736-2865
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Fax | 630-761-7549
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209028969
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License Number State | IL
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