Provider Demographics
NPI:1407539414
Name:DEETER, ANA DIANE (PA)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:DIANE
Last Name:DEETER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 JORIE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2219
Mailing Address - Country:US
Mailing Address - Phone:630-974-6602
Mailing Address - Fax:630-487-2411
Practice Address - Street 1:899 SKOKIE BLVD STE 260
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4019
Practice Address - Country:US
Practice Address - Phone:630-974-6602
Practice Address - Fax:630-487-2411
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant