Doctor Name: | MRS. DIANA LYNNE MONAGHAN |
NPI Number: | 1083711055 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 055-0030778 |
Business Practice Address: | 321 N La Grange Rd La Grange Park, IL - 605265622 |
Business Phone Number: | 7084851020 |
Business Fax Number: | |
Mailing Address: | 331 S Ridgeland Ave, Unit D OAK PARK |
State: | IL |
Postal Code: | 603023599 |
Phone Number: | 7083861030 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 01/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 055-0030778 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |