Individual provider Active NPI

Diana Warnecke, APN, CPNP

  • Pediatric Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1396183687
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209010353 Issued in IL
Practice address
420 NE Glen Oak Ave
Ste 401
Peoria, IL 61603-3105
Phone
(309) 624-9844
Fax
(309) 624-8884
NPI assigned
Jun 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209010353 IL Primary

Addresses

Primary practice location

420 NE Glen Oak Ave
Ste 401
Peoria, IL 61603-3105

Mailing address

114 Miromar LN
Washington, IL 61571-4020
Phone (309) 258-2555

Other identifiers 1

IdentifierTypeStateIssuer
376000511MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130806000090 IL Practitioner - Nurse Practitioner 8921240821 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209010353ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Trustees of the University of Illinois CurrentSince Jun 1, 2013 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jun 1, 2013 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Apr 10, 2019 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

302 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 662-5361

7694 Solutions Ctr
Chicago, IL 60677

420 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 655-2343

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

420 NE Glen Oak Ave
Ste 401
Peoria, IL 61603
Phone (309) 624-9259

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1396183687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 MIROMAR LN",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615714020",
            "telephone_number": "309-258-2555",
            "fax_number": "309-624-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 NE GLEN OAK AVE",
            "address_2": "STE 401",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033105",
            "telephone_number": "309-624-9844",
            "fax_number": "309-624-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARNECKE",
        "first_name": "DIANA",
        "credential": "APN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-07",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209010353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376000511",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.