Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 036059322 | IL |
NPI | 1013004639 |
---|---|
Provider Name | Dr. Elizabeth P Diaz |
First Address | Chicago, IL 60631-3745 |
Second Address | Chicago, IL 60631-3745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73840 | (02) | |
AD8968363 | DEA (01) |