Individual
DIAMOND BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1325 SYCAMORE RD, DEKALB, IL 60115-2483
(815) 501-1287
Mailing address
1325 SYCAMORE RD, DEKALB, IL 60115-2483
(773) 440-8968
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160154555
COUNTY CARE
IL
Enumeration date
09/06/2023
Last updated
09/06/2023
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