Provider Demographics
NPI:1306086491
Name:DIAMOND, CHRISTEL (APRN-FPA)
Entity type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:APRN-FPA
Other - Prefix:
Other - First Name:CHRISTEL
Other - Middle Name:
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-FPA
Mailing Address - Street 1:114 E COOK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2015
Mailing Address - Country:US
Mailing Address - Phone:224-504-1114
Mailing Address - Fax:
Practice Address - Street 1:114 E COOK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2015
Practice Address - Country:US
Practice Address - Phone:224-504-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000483363L00000X
IL209.006615363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner