Individual
ELIZABETH DIEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W REYNOLDS ST STE 203, PONTIAC, IL 61764-9774
(815) 844-5115
Mailing address
1105 N PRAIRIE VIEW LN, PONTIAC, IL 61764-1228
(815) 992-7208
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
041377192
IL
363LF0000X
Family Nurse Practitioner
Primary
209029298
IL
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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