Provider Demographics
NPI:1285479428
Name:MARYNIARCZYK, DIANE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:MARYNIARCZYK
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W 95TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2703
Mailing Address - Country:US
Mailing Address - Phone:708-888-8287
Mailing Address - Fax:
Practice Address - Street 1:2850 W 95TH ST STE 106
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2703
Practice Address - Country:US
Practice Address - Phone:708-888-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily