MEDICARE: DIANE IRISH

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209027202	IL

General Provider Information

NPI Number	:	1235520404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE IRISH

Provider Business Mailing Address
First Line	:	1950 W POLK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 E 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4051
Country	:	US
Telephone Number	:	312-572-3050
Fax Number	:	312-572-3060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	10/27/2025

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Directions to “ DIANE IRISH ” Practice Location

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