Provider Demographics
NPI:1487135208
Name:HILSON, DIANNA DENISE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:DENISE
Last Name:HILSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:DIANNA
Other - Middle Name:DENISE
Other - Last Name:HILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN FNP-BC
Mailing Address - Street 1:6421 OLD PLANK BLVD
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2975
Mailing Address - Country:US
Mailing Address - Phone:708-715-1669
Mailing Address - Fax:
Practice Address - Street 1:500 E 51ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF08180256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL757361OtherEMPLOYEE IDENTIFICATION NUMBER