Healthcare Provider Details

I. General information

NPI: 1932729340
Provider Name (Legal Business Name): ANGELA MELISSA REPEL FNP-DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 W MADISON ST STE 306
CHICAGO IL
60607-2191
US

IV. Provider business mailing address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

V. Phone/Fax

Practice location:
  • Phone: 312-624-9971
  • Fax:
Mailing address:
  • Phone: 312-947-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023661
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: