Provider Demographics
NPI:1124249693
Name:ECKHOUSE, DIANE R (MS,APN,OCNS-C)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:R
Last Name:ECKHOUSE
Suffix:
Gender:F
Credentials:MS,APN,OCNS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 HAMMERSMITH LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1080
Mailing Address - Country:US
Mailing Address - Phone:847-309-6453
Mailing Address - Fax:
Practice Address - Street 1:4412 HAMMERSMITH LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1080
Practice Address - Country:US
Practice Address - Phone:847-309-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist