Individual
MRS. DIANA LYNNE MONAGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
321 N LA GRANGE RD, LA GRANGE PARK, IL 60526-5622
(708) 485-1020
Mailing address
331 S RIDGELAND AVE, UNIT D, OAK PARK, IL 60302-3599
(708) 386-1030
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055-0030778
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009284
—
VT
01
—
055-0030778
LICENSE EXPIRES 01/31/20
VT
01
—
085.003465
LICENSE
IL
Enumeration date
09/20/2006
Last updated
01/13/2010
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