Provider Demographics
NPI:1548886542
Name:GRAMAN, DIANE (FNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:GRAMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:GRAMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2119 MANICO DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0812
Mailing Address - Country:US
Mailing Address - Phone:815-791-7445
Mailing Address - Fax:
Practice Address - Street 1:2119 MANICO DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0812
Practice Address - Country:US
Practice Address - Phone:815-791-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily