MEDICARE: DIANE M CALAMARAS RN CPNP

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	208000000X	Pediatrics Physician	209002438	IL

General Provider Information

NPI Number	:	1366490054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M CALAMARAS RN CPNP

Provider Business Mailing Address
First Line	:	1252 W CATALPA
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1337
Country	:	US
Telephone Number	:	773-728-8953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 CHILDRENS PLAZA
Second Line	:	BOX #30
City	:	CHICAGO
State	:	IL
Zip	:	60614-3394
Country	:	US
Telephone Number	:	773-868-8953
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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