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NPI Code Detail

MEDICARE: DIANNA J MCBRIDE F.N.P.

MEDICARE: DIANNA J MCBRIDE F.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209-004697IL

General Provider Information

NPI Number : 1235190059
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNA J MCBRIDE F.N.P.
Provider Business Mailing Address
First Line : 2020 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3741
Country : US
Telephone Number : 312-572-4503
Fax Number : 312-572-4511
Provider Business Practice Location Address
First Line : 1645 COTTAGE GROVE AVE
Second Line : COTTAGE GROVE HEALTH CENTER
City : FORD HEIGHTS
State : IL
Zip : 60411-3818
Country : US
Telephone Number : 708-753-5846
Fax Number : 708-753-5042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 04/27/2021

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