Healthcare Provider Details

I. General information

NPI: 1073730677
Provider Name (Legal Business Name): ANGELA M DADE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 SO COTTAGE GROVE
CHICAGO IL
60615
US

IV. Provider business mailing address

4340 S GREENWOOD AVE
CHICAGO IL
60653-3702
US

V. Phone/Fax

Practice location:
  • Phone: 773-548-1170
  • Fax: 773-548-1404
Mailing address:
  • Phone: 773-548-0404
  • Fax: 773-548-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: