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General NPI Number Information
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NPI Number | 1407539414
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Entity Type | Individual
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Provider Name | ANA DIANE DEETER PA
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Gender | Female
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 899 SKOKIE BLVD STE 260
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City | NORTHBROOK
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State | IL
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Zip | 60062-4019
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Country | US
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Telephone | 630-974-6602
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Fax | 630-487-2411
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Provider Business Mailing Address
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Address Line | 1100 JORIE BLVD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-2219
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Country | US
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Telephone | 630-974-6602
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Fax | 630-487-2411
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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