Healthcare Provider Details

I. General information

NPI: 1376032250
Provider Name (Legal Business Name): ANGELLIE PHEAP FALANA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELLIE PHEAP DAM FNP-BC

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

IV. Provider business mailing address

700 PASQUINELLI DRIVE
WESTMONT IL
60559
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax: 312-635-0050
Mailing address:
  • Phone: 630-323-8690
  • Fax: 630-323-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209015860
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041349825
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: