MEDICARE: DIANA RAICHICI FNP-C

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	363LP2300X	Primary Care Nurse Practitioner	209033609	IL

General Provider Information

NPI Number	:	1942170584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA RAICHICI FNP-C

Provider Business Mailing Address
First Line	:	1007 CHURCH ST STE 100
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-5910
Country	:	US
Telephone Number	:	815-995-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 CHURCH ST STE 100
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-5910
Country	:	US
Telephone Number	:	815-995-2776
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	12/17/2025

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