Healthcare Provider Details

I. General information

NPI: 1275848244
Provider Name (Legal Business Name): STACIE R SANTANGELO RN, MS, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 19-100 NORTHWESTERN MEDICAL GROUP
CHICAGO IL
60611-5969
US

IV. Provider business mailing address

1S450 SUMMIT AVE STE 165
OAKBROOK TERRACE IL
60181-3952
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4965
  • Fax: 312-695-0005
Mailing address:
  • Phone: 630-320-6871
  • Fax: 630-385-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number209005000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: