Individual
DIANA MUKAMUSONI FULAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2650 RIDGE AVE EVANSTON, IL 60201, EVANSTON, IL 60201
(847) 570-2000
Mailing address
1516 W TOUHY AVE APT 1A, CHICAGO, IL 60626-2631
(773) 546-8782
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.022042
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FNP
—
IL
Enumeration date
08/19/2021
Last updated
08/19/2021
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