Doctor Name: | CHARISSE DIMARIA |
NPI Number: | 1205063302 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209007616 |
Business Practice Address: | 1949 S Bridge St Yorkville, IL - 605609851 |
Business Phone Number: | 6303852360 |
Business Fax Number: | 6303852934 |
Mailing Address: | 1949 S Bridge St, YORKVILLE |
State: | IL |
Postal Code: | 605609851 |
Phone Number: | 6303852360 |
Fax Number: | 6303852934 |
NPI Enumeration Date: | 06/16/2009 |
NPI Last Update Date: | 11/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209007616 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |