Individual
MA R DIFANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 CURTIS RD, CHAMPAIGN, IL 61822-9678
(217) 365-6203
Mailing address
602 W UNIVERSITY AVE, PROVIDER ENROLLMENT NCW4, URBANA, IL 61801-2530
(217) 383-6792
(217) 326-2856
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004432
IL
Other
Enumeration date
06/22/2006
Last updated
11/21/2013
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