Healthcare Provider Details

I. General information

NPI: 1750858536
Provider Name (Legal Business Name): ANGELA VIOLANTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

1324 W PRATT BLVD APT 2E
CHICAGO IL
60626-5647
US

V. Phone/Fax

Practice location:
  • Phone: 312-771-3261
  • Fax:
Mailing address:
  • Phone: 586-489-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041403641
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041403641
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041403641
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number041403641
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: